St. Joseph Mercy Hospital Ann Arbor is a 537 bed hospital located in Superior Township between Ann Arbor and Ypsilanti. Our hospital has been a member of the HMS consortium from its inception in 2011 initially with the VTE initiative. In fall of 2013 we were a Pilot hospital for the PICC initiative and in 2015 as a Pilot hospital for the Antimicrobial Initiative. Our HMS Team includes Dr. David Vandenberg as physician champion for the VTE, Dr Tanya Boldenow as physician champion for PICC and Dr Anurag Malani as physician champion for the Antimicrobial Initiative. Jim Vandewarker acts as Quality Administrative lead for the projects. Ann Ruffolo is the primary clinical abstractor for all 3 projects.
As VTE has gone in to a maintenance mode in the Spring 2017 we have retired our VTE CPT (Collaborative Practice Team) and have resumed utilizing the hospital's Coagulation CPT as our oversight group for VTE concerns and issues. We have made much progress in completion of a VTE risk assessment on admission, providing proper VTE prophylaxis to high risk patients and avoiding unnecessary prophylaxis in low risk patients. Our automated VTE Risk advisor in our EMR will be undergoing needed improvements in the near future.
Our multi-disciplinary PICC Team meets monthly to review HMS data, review current literature, investigate all cases with complications and work on Quality Improvement initiatives. Our team includes our Physician Champion, the Director of Patient Care Services, Nursing Practice & Quality Support (Leadership), our 4 PICC RNs, the Clinical Abstractor, an Intensive Care physician and Clinical Nurse Leader, IR representatives, Heme/Onc physician, other hospitalists/residents and Nephrology. Our hospital inserts >1000 PICCs/year mostly by our PICC RNs at the bedside with the remainder by our IR department. We have designed a 'Difficult Access Decision Guide' that helps determine PICC appropriateness. We have made significant gains in reducing short term PICC use, choosing the proper number of lumens and avoiding PICC use in patients with an eGFR <45. We have worked diligently on reducing our Catheter Occlusion rates with multiple QI projects. CLABSI and VTE occurrences are rare but always of concern and each are investigated thoroughly.
Our hospital has a multidisciplinary Antimicrobial Subcommittee that meets quarterly. This is the operational body for our hospital's Antimicrobial Stewardship Program. HMS data is reviewed at those meetings. Data is presented regularly to high interest groups including residents and hospitalists. The HMS data has been useful in updating our institution's PNA guidelines. We continue to refine ongoing QI work around stewardship related bundles for UTIs and Transitions of Care.