July 2014
Clinical redesign initiatives

YNHHS’s clinical redesign initiative involves a systematic and comprehensive approach to improving the value of care delivery and measurably improving quality while aiming to reduce expenses by more than $60 million a year.

The clinical redesign initiative is structured around clinical services, with close partnerships and mutual accountability between nursing, physician and administrative leadership. Over 50 clinical redesign projects are under way, with key improvements to date in medicine, cardiology, orthopedics, surgery, oncology, laboratory medicine and children’s services. Clinical teams, finance, analytics and decision support staff identify redesign opportunities and track and measure project results. Clinical redesign implementation is supported by the Epic EMR and drives adoption of best practices across system providers.

The group has developed a robust measure of Quality Variation Indicators (QVIs), or a ranked series of adverse hospital events or conditions that are not present on admission. QVIrelated analyses capture the frequency and cost of complications in care delivery and allow clinical redesign teams that reduce the incidence of QVIs, such as procedure complications and infections, to accurately identify how their efforts have improved outcomes while decreasing the costs of care.

Clinical redesign has achieved over $11.7 million in expense reduction and revenue improvement to date. These savings and improvements are from reduced readmissions, decreased blood product utilization, a decrease in complications in small and large bowel surgery cases, improved hip fracture patient outcomes, improved sickle cell patient protocols, decreased psychiatry patient LOS, reduced incidence of ventilator-associated pneumonia, and improved valuebased purchasing performance.

Clinical redesign initiatives currently under way include standardization and improvement in ICU care, appropriately increased palliative care consults, reduced complications and improved LOS across a series of patient populations, advanced sepsis patient care, optimized lab and radiology utilization, and effective management of patients in cardiac and orthopedic care bundles.

Clinical redesign also drives integration with other highvalue initiatives across the health system, such as a bundled payment pilot program, high reliability organization implementation, value-based purchasing, Epic point of order price transparency and a system-wide communication plan designed to engage front line clinicians in improving care efficiency.

If you would like to learn more about clinical redesign or have an idea for a clinical redesign project, please contact the initiative’s sponsors, Tom Balcezak, MD(thomas.balcezak @ynhh.org), Alan Kliger, MD(alan.kliger@ynhh.org) or Ryan O’Connell, MD(ryan.o’connell@bpthosp.org).