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Richard Larson, MD, Chief of Emergency Medicine and Stephen Wright, MD, Chief of Medicine at Faulkner Hospital were guest speakers at a May 15 MassHealth Hospital Quality Forum sponsored by MASSPRO and the Center for Health Policy and Research at UMASS Medical School.

Doctors Larson and Wright were invited to give a presentation titled "Implementation of Practices that Contribute to Improved Performance in Pneumonia Care", as a result of Faulkner's distinction of 100% compliance in the JCAHO Pneumonia Core Measures.

Pneumonia Core Measures include oxygenation assessment, blood cultures, antibiotics within 4 hours, antibiotic selection, smoking assessment and vaccination status (pneumococcal vaccine and influenza vaccine). The University Health Consortium (UHC) mean scores are very good with none below 98.9%. However, since January 2004, Faulkner Hospital has scored consistently at 100%. Other hospitals want to know how this has been achieved.

Keys to success at Faulkner, leading to Best Practices status, include the following: JCAHO Core Measures require that antibiotics must be given within 4 hours and that antibiotic selection is key to successful outcome. Faulkner’s PACS (picture archiving communication system) allows ED attending physicians to see films electronically immediately, which significantly enables treatment within the 4-hour window. Most importantly, educating staff to get blood cultures before giving antibiotics has been a major initiative at Faulkner, although the value of blood cultures is currently being evaluated nationally. Dr. Larson and Dr. Wright also attribute Faulkner’s use of standard guidelines as keys to success in antibiotic selection.

Addressing the Core Measures of Smoking Cessation and Vaccination Status have been major practice initiatives at Faulkner. In Fall 2004, the Hospital implemented the addition of blood culture documentation to the ED screen. A sentinel development was the introduction of an “Opt-Out” mechanism created and approved by the Hospital’s Medical Executive Committee. The initiative involved one FTE Nursing Educator who was hired to cover floors, educate RN staff, and to implement a standard of administering pneumococcal and influenza vaccine to every patient, unless the patient or the physician choose to “opt-out”. The benefit of this practice, according to Dr. Wright, is that “Practice has been shown to maximize the number of vaccinations performed, without relying on caregivers to remember to order vaccine at each encounter.”

Additionally, in the summer of 2005, Faulkner built patient vaccination status into the electronic Nursing Assessment on admission to the hospital. Smoking status and patients’ interest in a smoking cessation program were also added to the electronic Nursing Assessment. These electronic cues are keys to the Hospital’s Best Practice success.

In other areas of recognition for quality performance, the Faulkner received a High Reliability Award at the MASSPRO “Celebrating Hospital Quality in Massachusetts Forum” on May 19, 2006. This award is given to hospitals that have demonstrated 100% reliability in Acute Myocardial Infarction and Heart Failure for at least two quarters of publicly reported data on Hospital Compare. Far exceeding the minimum requirement, Faulkner Hospital was the top hospital for six quarters.