UTMB Health uses Vizient data to improve patient care quality

Using their standing in annual national hospital rankings to compare themselves to peers is not new for hospitals and health systems always seeking to improve. The University of Texas Medical Branch (UTMB) is no different in that regard. What makes UTMB stand out is the unique way they’ve used one national ranking, the Vizient® Quality and Accountability Ranking, to guide not just improvement, but transformation in quality, safety and patient experience.

UTMB, a comprehensive academic medical system in Galveston, Texas that is a part of the University of Texas System, relies on the Vizient Quality and Accountability Ranking to gain insight on where to focus efforts to improve patient care. The ranking measures annual performance across safety, mortality, effectiveness, efficiency, patient centeredness and equity using data from the Vizient Clinical Data Base (CDB).

UTMB is the oldest academic medical center in Texas and is composed of four campuses, a network of hospitals, research facilities and clinics. Its academic health system covers a large underserved and underinsured patient population. UTMB has used the Vizient CDB since 2004 but has historically ranked in the middle among its peer academic medical centers in the annual Quality and Accountability Ranking partially due to its unique challenges as a safety-net provider.

“We serve a fairly large Medicare and Medicaid population,” says Gulshan Sharma, MD, MPH, senior vice president, chief medical and clinical innovation officer at UTMB. “Almost 40% of our patient mix is Medicaid and about 8%-10% is unfunded. We looked at the vulnerable population we serve and said to ourselves that our patients deserve better, so we need to look at our opportunities.”

Striving to deliver the Best Care possible

In 2016, the system set a bold goal: it wanted to rank among the top 20 academic medical centers in the U.S. by 2018 as measured by the Vizient Quality and Accountability Rankings. The motto “Best Care” was chosen to engage everyone in helping meet the goal.

Creating a sense of connection was important. The system’s CEO shared patient and staff stories, and weekly education sessions were held to review domain areas including mortality, safety and patient experience to make sure everyone understood the goals and objectives of their efforts.

The initiative was a resounding success. By 2017, UTMB moved an astounding 67 positions within the Quality and Accountability scorecard, going from #76 to #9 within a year. By continuing its efforts, UTMB climbed to #4 the next year. From 2017–2019, UTMB maintained its place within the top 10 of all comprehensive academic medical centers across the country.

However, when the COVID-19 pandemic swept across the U.S. in March 2020 it challenged providers everywhere to maintain patient safety and margins. During the pandemic, UTMB expanded by building regional campuses in Clear Lake and League City while managing a surge in contract labor costs and overcoming retention challenges by focusing on workforce wellbeing.

Using clinical data to guide their Journey to Zero

As Covid-19 patient volume lessened in 2022, Dr. Sharma reignited quality efforts with a new initiative called “Journey to Zero.” The goal was zero patient safety events and reducing unavoidable events, such as readmissions, as much as possible.

As part of this effort, Rachel Ussery, DNP, RN, CNL, CCRN, critical care nurse manager at UTMB, championed patient safety and infection control best practices to help improve 10 areas, including central line bloodstream infections (CLABSI), catheter-associated urinary tract infections (CAUTI), pressure ulcers, and readmissions.

“I lead daily audits for every patient in the ICU for lines and catheters to ensure all best practices are followed. If it is not indicated, I ask the provider if we can take the line or foley out,” said Ussery. “Having a dedicated person helps to reduce infections.”

In addition, efforts to reduce CLABSIs resulted in a decrease from 69 to 35 cases compared to the previous period ending in 2023.

UTMB also rolled out a tool for nurses to document patient status when doing rounds using their process coined as “AIDET: acknowledge, identify, discuss, explain, thank.” This process has been standardized across the enterprise so that everyone understands how to communicate with patients.

The keys to success, beyond having accurate clinical data and goals in place, were face-to-face education and regular communication. To keep the team excited and focused on progress, UTMB established quarterly awards to recognize teams.

Incorporating a dedicated analyst

To help UTMB get the most value from the CDB, a dedicated analyst on their team uses the platform to report on trends, strengths, variances, and opportunities for process improvement. Melissa Hall, MBA, healthcare analyst at UTMB, shares data with different departments and service lines, including monthly executive level meetings leveraging her expertise in report building.

By seeing their progress over time, the team has bought into using the CDB and the Quality and Accountability Ranking to improve care quality. While looking at reports and performance trends has helped guide focus areas, the daily work to deliver the best possible patient care comes down to everyone at the hospital doing what they can provide.

“It is not just about providing the best care and making sure the patient is comfortable,” says Leticia Castillo, MD, co-director and professor of pediatrics at UTMB Children’s Hospital Pediatric Critical Care Unit (PICU). “Its about understanding what the patient perceives with the care we provide and sometimes there is a dissonance with our perception and what the patient is really feeling.”

Achieving care improvement milestones

Due to their cumulative efforts, UTMB has most recently been ranked No. 24 out of 116 comprehensive academic medical centers according to the 2024 Vizient Quality and Accountability Period 1 scorecard.

However, the work is far from over. Dr. Sharma, Dr. Castillo and Ussery continue to lead efforts across facilities and campuses to help UTMB operate as a single, unified academic medical center.

“When you look back at what has happened at UTMB over the past five years, it’s quite transformational,” said Dr. Sharma. “We became a system, and right when we were trying to make a system we had a pandemic.” He continued, “We are regrouping. We have a new president, Jochen Reiser, MD, PhD, and he has challenged me to set the bar for UTMB to be the best in all of our endeavors. It’s not about the ranking, we have already made it to 5-star before. It’s all about patient care. Our patients deserve it and we owe it to them.”

About The University of Texas Medical Branch

The University of Texas Medical Branch (UTMB Health) is a major academic health sciences center and research enterprise that has been serving Texas since 1881, dedicated to advancing healthcare through exceptional patient care, education, and research.