What is "True North" and why is it important? Please read here to learn more.
How are we doing with our True North metrics?
Please review our currentTrue North scorecard that continues to serve as one lens into our organizational priorities and performance. This month's communication focuses on our two highlighted ambulatory quality metrics.
How are we working to improve our Advanced Care Planning efforts?
Advanced Care Planning (ACP) is defined as making decisions about the care you want to receive if you become unable to speak for yourself; they are based on personal values, preferences and discussions with your loved ones. Within UCSF Health, providers have pointed out the wide variability in APeX documentation for goals of care, discrepancies in access to ACP documentation between ambulatory and inpatient settings, and variable skill levels and comfort in having these conversations. The attached slides provide an overview of the tactics planned to address these opportunities, which include provider training, a patient-oriented outreach campaign, and EMR documentation standards. We look forward to sharing progress and appreciate your collective efforts to have important ACP discussions with your patients.
How are we trying to address disparities in hypertension for our patients?
Disparities in hypertension control are a well-described national problem and UCSF Health is unfortunately no different. Last year, in comparison to our total primary care population (75.25%) and the subset of our white patients (77.72%), our African-American patients experienced lower rates of achieving goal blood pressure (64.19%). Our Population Health and Primary Care teams have begun testing new visit types, clinical protocols and outreach efforts to eliminate the disparity. More broadly, we'll look forward to sharing emerging strategies to bring greater focus and visibility to healthcare disparities across our organization through the leadership of our UCSF Health Equity Council.
News and Announcements
New California Mandate: Naloxone Prescribing & Education
The California State Legislature passed into law a new mandate that requires providers to make naloxone more readily available to patients, effective January 1st. A communication and slide decksent earlier this week outlined our UCSF Health Best Practice Alert (BPA) solution in APeX, which provides a reminder and option for a single-click naloxone prescription added to your ambulatory and discharge prescriptions. If you're interested to learn more about our broader Opioid Stewardship Initiatives, we're sharing a recent presentation to the Chancellor's Council as we look forward to bringing improved tools and resources in the coming year.
Nurse-Driven Protocol for Urinary Catheter Removal
Protecting our patients from catheter-associated urinary tract infections (CAUTI) requires a multidisciplinary and multi-pronged approach. Nurse-driven protocols (NDP) that enable and empower nurses to make decisions about catheter removal is a key part of the approach. This strategy is widely adopted at other academic medical centers and part of nationally developed toolkits for CAUTI prevention. Starting in mid-February, with many thanks to our nursing leadership and bedside nurses, our patients will benefit from the same practice at UCSF Health. Stay tuned for more details coming soon.
Rethinking Antibiotic Use: A Helpful Framework
A couple months ago, we highlighted our Antimicrobial Stewardship programs and the impact they're having on prescribing practices, antibiotic utilization, and unwanted practice variation. A recent JAMA viewpoint reinforced our local efforts by advocating for four "moments of antibiotic decision-making" that is a nice guide and teaching tool; it highlighted the moments to ask: 1) Does this patient have an infection that requires antibiotics? 2) Have I ordered appropriate cultures before starting antibiotics? 3) A day or more has passed. Can I stop them? Can I narrow therapy? Can I change to oral from IV? and 4) What duration of therapy is needed? Adoption of these basic principles can make a significant impact for our patients.
Looking for information from a past True North Newsletter? Please access them here.