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Small Hospitals, Big Outcomes by Kim Phagan Hansel

As quality director at Memorial Hospital of Converse County Missy Swanson constantly reviews patient charts. Part of her daily duties include continually evaluating data, examining files and comparing information to ensure that every patient is receiving the highest quality of care possible.

As a small hospital with just 25 beds, Memorial Hospital of Converse County serves the unique needs of the community's citizens. Because of the hospital's distance to other larger hospitals, it is identified as a critical access hospital, which allows the hospital to focus on "providing care for common conditions and outpatient care, while referring other conditions to larger hospitals."

As of April, there are 1,332 certified Critical Access Hospitals located throughout the United States, with 16 in Wyoming. Memorial Hospital of Converse County is ranked in the top 100 critical access hospitals in the country by the National Hospital Association.

Because of the smaller number of patients the hospital serves compared to larger hospitals, Memorial Hospital of Converse County is not required by the Centers for Medicare and Medicaid Services to track all performance measures. However, in an effort to be as transparent as possible, Memorial Hospital of Converse County leadership officials monitor its performance and measures that against other hospitals in the state and region.

"We do this because we want to be as transparent as the hospitals around us," Swanson said. "We want to meet these measures."

In a large majority of the categories, Memorial Hospital of Converse County outperforms other area hospitals. The hospital has a lower mortality rate, better compliance care, fewer 30 day readmissions, shorter average lengths of stay, shorter time to service and lower episode costs than the U.S. Health Systems averages reported in the April issue of Modern Healthcare.

Meeting and maintaining those high performance numbers has come from much due diligence on the part of the hospital to ensure that patients' needs are being met and patient care is at the highest of standards. For that reason, Swanson is constantly viewing and evaluating the data to determine where there may be areas in need of improvement.

One of the first areas identified during the data review, was the need to reduce patient falls while in the hospital. Hospital-wide fall prevention education and the implementation of new evidence-based practices have helped to create a higher quality of patient care.

"We changed our policies and did hospital-wide fall prevention competency training," Swanson said. "We've had zero falls since implementation."

Because of the fall prevention success, the hospital leadership has also started implementing training and evidence-based practices for other patient health concerns. A process has now been developed to ensure that patients with urinary catheterization don't develop urinary tract infections.

"There was no standardized process for a catheterization," Swanson said. "Now we have a process that every practitioner follows with these patients."

By implementing standardized, evidence-based practices, the hospital has been able to maintain the quality measures which have equaled better patient outcomes. For the most recent reporting period, Memorial Hospital of Converse County was at 100 percent for removing urinary catheters on the first or second day after surgery, leading the Wyoming average by two percent.

Similar to implementing the fall prevention procedures and procedures to reduce and eliminate urinary tract infections, another new policy is in the development process. Procedures to ensure that patients don't develop sepsis, a life-threatening condition that arises when the body's response to infection injures its own tissues and organs, are currently being created.

All of these procedures and guidelines the hospital has implemented are designed to create better outcomes for patients. In the last six years, the Memorial Hospital of Converse County has received numerous awards from Mountain Pacific Quality Health for having no Catheter-associated Urinary Tract Infections, Central Line-associated Bloodstream Infections or Clostridium difficile Infections (more commonly known as C. Diff infections).

"We want to hit quality of care patients are getting 100 percent of the time," said Memorial Hospital of Converse County CEO Ryan Smith. "We want them to get the evidence-based care they deserve."

That attention to detail that has helped Memorial Hospital of Converse County meet and exceed expectations. All of these are just part of the master plan for providers and staff to provide the best, most quality care possible.

"At smaller hospitals, you have the opportunity to truly care about the person," Swanson said. "A lot of these people are family to someone we know. When you know people, it changes the way you care for them."

That has meant implementing 15 to 20 rapid response improvement teams that help address issues when they do arise. From creating systems that help to prevent patient falls to other process designed to decrease incidents of urinary tract infections with catheterizations. By implementing the processes and establishing improvement goals, the hospital staff is able to quickly identify problems when they occur and address them rapidly.

"We use rapid response teams to fix what we need to," Smith said.

"We send our sicker patients to our partner hospitals," Swanson said. "We don't have the specialty care to take care of them here."

For that reason some statistics such as the .51 mortality rate at MHCC is much lower than the U.S Health System average of 1.01.

"The care we give is equal to or better than other hospitals," Swanson said. "They get more personal care and things get caught quicker."

Hourly roundings have been created that require nurses to check on patients each hour and check on a number of items from patients, from what their pain level is and if they need to use the restroom to helping them change positions or getting them a drink of water. The hourly roundings help patients not only feel as if they're being well taken care of, but it also helps to go through the check list of items to ensure a patient doesn't fall or the catheter isn't becoming a problem that could lead to a urinary tract infection.