FMOL Health, a 10-hospital system based in Baton Rouge, La., measures two patient safety metrics most other hospitals do not: whether patients leave the hospital as mobile as they arrived, and whether they acquire any bloodstream infection.
CMS requires hospitals to track and report on central line-associated bloodstream infections (CLABSIs), but not all bloodstream infections. The agency also mandates reporting on patient falls and hospital-acquired pressure injuries , but not whether patients’ mobility declines.
Christopher Thomas, MD, vice president and chief quality officer of the health system, told Becker’s the CMS-required quality measures are device- and event-specific and cover a slice of patients. Although it is more work, FMOL Health organizes around patient-centered clinical themes.
Hospital-acquired disability
A six-month survey of more than 800 patients readmitted to FMOL Health revealed two gaps in care: some patients were readmitted because they did not understand their first discharge plan, and others functionally declined during their stay and returned home weaker, and thus more prone to health risks.
Dr. Thomas said perioperative units are often on top of mobility, as surgical patients commonly receive a “we’ll get you up and walk you” prescription, but that is more rare for patients in medical units. That is why the system rolled out its mobility initiative first in medical units, then in surgical ones.
Over the last five years, FMOL Health has partnered with Baltimore-based Johns Hopkins Medicine, which created a 1-to-8 scale to measure mobility. A “1” is a patient who can only lie in bed, and an “8” is one who can walk 250 feet or more.
At FMOL Health, physicians set a mobility baseline at admission, as well as a daily order and goal. Physicians and nurses follow through with the goal and track progress on weekly boards. The care team now shares the same language, according to Dr. Thomas.
Since launching the process to reduce hospital-acquired disability rates, FMOL Health has lowered length of stay by 1.4 days among patients admitted to the ICU who stay more than three days, lowered its HAPI rate, and increased discharge-to-home orders by 18% in a progressive care unit, without seeing an increase in falls.
“Everyone’s so worried about someone falling that when you first say you’re going to turn yourself into a mobility hospital, you really got to think about all the devices and everything that goes along with it,” Dr. Thomas said, adding that “mobility is medicine.”
Bloodstream sterility
The system also took a broader view of hospital-onset bloodstream infections. Dr. Thomas said patients do not care whether an infection came from a central line or peripheral IV; they care about having one.
This is “a dramatically higher bar” than monitoring CLABSI alone, Dr. Thomas said, but worth it.
Three times a day, a clinician completes a “pain” assessment on peripheral IVs: “P” for pain-free during a flush or infusion, “A” is an antiseptic on swab caps, “I” is guaranteeing an insertion is visually checked for redness or other reactions, and “N” is neatness, meaning the dressing does not have blood or excess tape on it.
FMOL Health also uses closed-IV systems and identifies risks for each patient. For example, if emergency medical services inserted an IV, clinicians will replace the IV in case the original is unsterile.
Dr. Thomas also highlighted the role of phlebotomists as proceduralists. During a blood culture draw, a purple sign alerts other clinicians to not wander in and potentially introduce a contaminant.
In September, inpatient blood culture contamination rates were 0.4%, well below the national goal of 1.5%, Dr. Thomas said.
CMS’ hospital-onset bacteremia and fungemia measure, currently a voluntary pilot, is the precedent for FMOL Health’s work. Dr. Thomas expects the measure to become mandated by 2028.
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