NorthShore University HealthSystem actively monitors the quality and patient safety provided to patients throughout our system according to our Performance Improvement Plan.  Click on the highlighted term below to see the graph and additional information about the measure. Please revisit this page from time to time as we update the existing measures and add new ones.


Acute Myocardial Infarction (Heart Attack Care)

AMI-1 Aspirin at Arrival: % of acute myocardial infarction (AMI) patients without aspirin contraindications who received aspirin within 24 hours before or after hospital arrival
NorthShore Q4 2012
100%
Decile Benchmark
100% 

AMI-2 Aspirin Prescribed at Discharge: % of acute myocardial infarction (AMI) patients without aspirin contraindications who are prescribed aspirin at hospital discharge
NorthShore Q4 2012
97.3%
Decile Benchmark
100%  

AMI-3 ACEI or ARB for Left Ventricular Systolic Dysfunction: % of acute myocardial infarction (AMI) patients with left ventricular systolic dysfunction (LVSD) and without angiotensin converting enzyme inhibitor (ACEI) contraindications who are prescribed an ACEI at hospital discharge
NorthShore Q4 2012
80%
Decile Benchmark
100%  

AMI-5 Beta Blocker Prescribed at Discharge: % of acute myocardial infarction (AMI) patients without beta blocker contraindications who are prescribed a beta blocker at hospital discharge
NorthShore Q4 2012
100%
Decile Benchmark
100%  

AMI-8a PCI Received Within 90 Minutes of Hospital Arrival: % of eligible patients having a percutaneous cardiac intervention (PCI) within 90 minutes of arrival at the hospital
NorthShore Q4 2012
100%
Decile Benchmark
100% 

Heart Failure

HF-1 Discharge Instructions Received: % of eligible patients with heart failure receiving detailed instructions at discharge
NorthShore Q4 2012
95.2%
Decile Benchmark
100%  

HF-2 Left Ventricular Function Assessment: % of heart failure patients with documentation in the hospital record that left ventricular function (LVF) was assessed before arrival, during hospitalization, or planned for after discharge
NorthShore Q4 2012
100%
Decile Benchmark
100%  

HF-3 ACE Inhibitor for Left Ventricular Systolic Dysfunction: % of heart failure patients with left ventricular systolic dysfunction (LVSD) and without angiotensin converting enzyme inhibitor (ACEI) contraindications who are prescribed an ACEI at hospital discharge
NorthShore Q4 2012
94.1%
Decile Benchmark
100%  

Community Acquired Pneumonia

PN-3b Blood Cultures Performed Before First Antiobiotic Received: % of patients with community acquired pneumonia having blood culture tests performed before first antiobiotic was received
NorthShore 
Q4 2012
100%
Decile Benchmark
100%  

PN-6 Initial Antibiotic Selection for CAP in Immunocompetent Patients: % of patients with community acquired pneumonia whose initial antibiotic treatment was appropriate antibiotic
NorthShore Q4 2012
84.6%
Decile Benchmark
99.0%  

Surgical Infection Prevention (CABG, Other Cardiac, Colon, Hip and Knee Replacements, Hysterectomy, Vascular Surgeries)

SCIP-1 Prophylactic Antibiotic Received Within 1 Hour Prior to Surgical Incision: % of eligible surgical patients receiving prophylactic antibiotic (to prevent infection) within 1 hour prior to surgical incision
NorthShore Q4 2012
98.9%
Decile Benchmark
100%  

SCIP-2 Prophylactic Antibiotic Selection for Surgical Patients (Appropriate): % of eligible surgical patients who had an appropriate prophylactic antibiotic selected
NorthShore Q4 2012
100%
Decile Benchmark
100%  

SCIP-3 Prophylactic Antibiotics Discontinued Within 24 Hours After Surgery End Time: % of eligible surgical patients having prophylactic antibiotics discontinued within 24 hours after the end of surgery
NorthShore Q4 2012
97.7%
Decile Benchmark
100%  

SCIP-VTE-1 Recommended VTE (Blodd Clot) Prophylaxis: % of patients with recommended venous thromboembolism prophylaxis ordered
NorthShore Q4 2012
100%
Decile Benchmark
100%  

SCIP-VTE-2 Received Appropriate VTE (Blood Clot) Prophylaxis: % of patients who received appropriate venous thromboembolism prophylaxis within 24 hours prior to surgery to 24 hours after surgery
NorthShore Q4 2012
100%
Decile Benchmark
100%  

 

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