Value Compass Concepts

Patient safety is about more than the hands-on care delivered in a hospital or clinic. It’s also about what caregivers do to close care gaps and be sure patients get the care they need.

To ensure this happens with every abnormal prostate, breast, pelvic, osteoporosis and fecal exam, the Georgia region established a centralized Outpatient Safety Net Program. Almost four years ago, borrowing techniques from Southern California’s successful safety net program, the Georgia region dedicated the equivalent of four full-time and one part-time nurse. Their jobs: to continue reaching out to patients who don’t respond to an initial contact regarding an abnormal test result.

The program is saving lives—and has earned KP’s 2014 David M. Lawrence Patient Safety Award in the transfer category, an award for a region that successfully implements a project from an earlier award winner. The Southern California safety net system had won a 2012 Lawrence award for its work.

“If you have an abnormal stool test, you should be seen in gastroenterology,” says Rahul Nayak, MD, who served as physician program director of patient safety for Georgia when the program launched. “It will raise a red flag in our system if that doesn’t happen in a certain amount of time. That’s why it’s called a safety net—it’s the net below the tightrope walker.”            

Making contact with patients

Sonja “Patrice” Evans, RN, is the manager of Georgia’s outreach effort and leads the group of nurses. She also steps in to convince members who initially say they don’t want to come in for further testing. “We can prevent something small from turning into something big,” she says.

The nurses receive a list of patients who have abnormal results. They make two attempts to reach them by phone and send a certified letter if the calls don’t work. “Our team tries to catch a small group of patients before they fall through the cracks,” Evans says.

So far, it’s working.

A systematic approach

In 2013, the most recent year for which data are available, 4,000 members were contacted about abnormal breast exam results. Of those, 93 percent were successfully scheduled for a follow-up appointment within the prescribed seven days. For abnormal pelvic exam results, 2,000 members were contacted, and 95 percent of those were scheduled within seven days.

Five hundred members—most of whom had declined or not responded to previous contacts—were reached within 100 days of abnormal prostate exam results; 87 percent scheduled a follow up. The team contacted 200 members with abnormal osteoporosis exam results, and more than 70 percent scheduled a follow up within 30 days, which exceeded the Medicare 5-Star guidelines.  

Dr. Nayak, UBT co-lead for gastroenterology at Southwood Medical Center, says one of his patients benefited from the program.

“Our safety net caught a positive (fecal occult blood test) that I had missed two months prior,” he said when accepting the Lawrence award on behalf of the team. “That patient had an advanced adenoma which was well on its way to malignancy. Without the safety net, there is no guarantee that we would have found this polyp” in time.

Now, Georgia’s program is expanding and will include other types of patient notifications.

Kaiser Permanente and the Coalition of Kaiser Permanente Unions have reached a formal agreement that ensures the safety and compensation of KP employees involved in caring for patients with the Ebola virus.

The agreement, reached December 15, 2014, clarifies questions coalition unions had about the engagement and protection of their members who may encounter or care for a patient with Ebola. It codifies standards outlined by the Centers for Disease Control around protective protocols and equipment. It also outlines training and support provided to employees, including for employees who may be unable to work during an isolation period for a possible Ebola exposure.

Safeguarding workers and patients

“As health care workers, we’re used to putting our patients first,” said Ken Deitz, president of United Nurses Associations of California (UNAC). “Because Ebola is an infectious disease, to maintain patient safety we also had to ensure our own safety.”

The parties came to agreement quickly and with little disagreement, with conversations focused on clarifying the practices KP facilities already are doing as outlined by Centers for Disease Control guidelines.

Union and KP leaders say it reflects their desire to work together—and to continue to focus on educating, protecting and preparing employees who may come in contact with Ebola patients.

“By working together, we have ensured that employees are prepared to care for patients with Ebola while keeping themselves and their colleagues protected from infection,” said Kathy Gerwig, vice president of Employee Safety, Health and Wellness for KP.

Education, training and protection

Specific provisions of the agreement include:

• All employees with the potential to interact with, treat, or do cleaning or waste handling for suspected Ebola patients will receive paid time for education and training in such areas as Ebola signs and symptoms; care and treatment; proper donning and doffing of personal protective equipment; proper cleaning of treatment rooms or areas; and proper disposal of the patient’s body fluids and wastes.
• Employees in key treatment or intake areas will receive sufficient personal protective equipment supplies.
• Ebola treatment teams would be staffed by volunteers. If there are not enough volunteers, local KP and union leaders would identify team members.
• If a coalition union-represented employee cannot work, or receives care as a result of work-related exposure to Ebola, the employee will receive paid time off, and all medical costs will be covered through workers’ compensation.

Read the agreement.