The Air Force-developed approach, in tandem with civilian researchers, is what clinicians call the “military acuity model,” which Lt. Col. Jarod Mort, a clinical nurse specialist, is credited with bringing to Wright-Patterson.
“We analyze all the areas that could potentially go wrong,” said Mort, likening it to the “Swiss cheese effect.”
“We’re trying to concentrate on those holes and plug them. By concentrating on just those few things, we can stop a huge assortment of catastrophic events early on.”
The model also provides a “minute-by-minute status” of a patient’s well-being using acuity scores based on vital signs, laboratory results and other health data, he said. If a patient appeared at high-risk for a medical problem, consultations could be scheduled with medical experts before something, such as heart failure, might occur.
The work focused on in-patients at Wright-Patterson starting in January 2014.
The failure-to-rescue rate, or the inability to stop preventable deaths, reached eight in 2013 among in-patients, and dropped to one in both 2014 and 2015 after the patient-care methods were put in place at Wright-Patterson, according to Mort.
“That was a significant improvement,” he said.
Mort, now stationed in Mississippi, credited the approach to decreasing patient stays to two days from two and a half days at Wright-Patterson. The base hospital averages about 3,400 inpatient admissions and 3,100 surgeries a year, hospital statistics show.
John Hopkins University cancer researchers in Baltimore, Md., conducting their own tests on the work-flow method reported they were able to see more patients, and help those they treated avoid return visits for preventable problems.
The study identified duties in a pancreatic cancer clinic that could be safely assigned to support staff, and the tasks, if missed or mishandled, would cost time and lead to avoidable health symptoms or might prompt emergency room visits, according to the university.
The findings led the Wright-Patterson neurology outpatient clinic to take a close look at how to balance work loads and improve patient care, two clinic doctors said.
“The goal is through prevention of task saturation you increase reliability …. and by increasing reliability you can also increase productivity,” said Dr. Aven Ford, a medical center neurologist. “The idea is you have to prevent people from getting overloaded because that’s when tasks get dropped.”
The neurology clinic made a list of “every single task that we do” to discover redundancies, said Dr. Caelen Ford, a Wright-Patterson neurologist married to Aven Ford. Both are also Air Force officers.
“What we found by looking through all this is that … tasks were getting done more than once and no one realized it,” she said. “Or one person would do a few tasks, and forget one and then someone else would have to go back and do the other one again. And the process of that redundancy started to sap away our productivity.”
“By figuring out which tasks you can fix ahead of time, you allow people to focus more on working with the patient, when the patient is there in your office,” Aven Ford said.
In time, the procedures could be rolled out to other Wright-Patterson outpatient clinics, which treat more than 300,000 patients at the base hospital every year, officials said.
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