The Joint Commission
Quality Check


  Symbol Key
This organization achieved the best possible results
This organization’s performance is above the target range/value.
This organization’s performance is similar to the target range/value.
This organization’s performance is below the target range/value.
Not displayed
Quality Report
Hospital
Butler Hospital
Org ID: 601

National Quality Improvement Goals: Hospital-Based Inpatient Psychiatric Services

Reporting Period: July 2014 - June 2015

  Compared to other Joint Commission Accredited Organizations
Measure Area
Nationwide Statewide
Hospital-Based Inpatient Psychiatric Services
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This organization’s performance is similar to the target range/value.
This organization’s performance is similar to the target range/value.

  Compared to other Joint Commission Accredited Organizations
  Nationwide Statewide
Measure Hospital
Results
Top 10% Scored at Least : Average Rate: Top 10% Scored at Least: Average Rate:
 
Assessment of violence risk, substance use disorder, trauma and patient strengths completed - Overall Rate
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(See Quarterly Results)
This organization’s performance is above the target range/value.
100% 93% ----3 ----3
97% of
1156 eligible Patients
Assessment of violence risk, substance use disorder, trauma and patient strengths completed - Children (1-12 years)
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(No Quarterly Results are available)
Not displayed.
4
100% 97% ----3 ----3
----
Assessment of violence risk, substance use disorder, trauma and patient strengths completed - Adolescent (13-17 years)
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(See Quarterly Results)
This organization’s performance is above the target range/value.
100% 96% ----3 ----3
99% of
291 eligible Patients
Assessment of violence risk, substance use disorder, trauma and patient strengths completed - Adult (18-64 years)
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(See Quarterly Results)
This organization’s performance is above the target range/value.
100% 93% ----3 ----3
98% of
711 eligible Patients
Assessment of violence risk, substance use disorder, trauma and patient strengths completed - Older Adult (>= 65 years)
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(See Quarterly Results)
This organization’s performance is similar to the target range/value.
100% 90% ----3 ----3
92% of
153 eligible Patients
 
Patients Discharged on Multiple Antipsychotic Medications Overall Rate
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(See Quarterly Results)
This organization’s performance is similar to the target range/value.
1% 10% ----3 ----3
5% of
617 eligible Patients
Patients Discharged on Multiple Antipsychotic Medications Children Age 1 - 12
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(No Quarterly Results are available)
Not displayed.
3
0% 2% ----3 ----3
----
Patients Discharged on Multiple Antipsychotic Medications Adolescents Age 13 - 17
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(See Quarterly Results)
This organization’s performance is above the target range/value.
0% 3% ----3 ----3
1% of
109 eligible Patients
Patients Discharged on Multiple Antipsychotic Medications Adults Age 18 - 64
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(See Quarterly Results)
This organization’s performance is similar to the target range/value.
2% 12% ----3 ----3
7% of
429 eligible Patients
Patients Discharged on Multiple Antipsychotic Medications Older Adults Age 65 and Older
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(See Quarterly Results)
This organization’s performance is similar to the target range/value.
0% 8% ----3 ----3
1% of
79 eligible Patients
 
Multiple Antipsychotic Medications at Discharge with Appropriate Justification Overall Rate
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(See Quarterly Results)
Not displayed.
3
100% 59% ----3 ----3
65% of
26 eligible Patients3
Multiple Antipsychotic Medications at Discharge with Appropriate Justification Children Age 1 - 12
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(No Quarterly Results are available)
Not displayed.
3
100% 49% ----3 ----3
----
Multiple Antipsychotic Medications at Discharge with Appropriate Justification Adolescents Age 13 - 17
Read More


(No Quarterly Results are available)
Not displayed.
4
100% 48% ----3 ----3
----
Multiple Antipsychotic Medications at Discharge with Appropriate Justification Adults Age 18 - 64
Read More


(See Quarterly Results)
Not displayed.
3
100% 61% ----3 ----3
71% of
24 eligible Patients3
Multiple Antipsychotic Medications at Discharge with Appropriate Justification Older Adults Age 65 and Older
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(No Quarterly Results are available)
Not displayed.
4
100% 54% ----3 ----3
----
 
Post Discharge Continuing Care Plan Created Overall Rate
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(See Quarterly Results)
This organization’s performance is similar to the target range/value.
100% 92% ----3 ----3
95% of
1398 eligible Patients
Post Discharge Continuing Care Plan Created Children Age 1 - 12
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(No Quarterly Results are available)
Not displayed.
4
100% 96% ----3 ----3
----
Post Discharge Continuing Care Plan Created Adolescents Age 13 - 17
Read More


(See Quarterly Results)
This organization’s performance is similar to the target range/value.
100% 96% ----3 ----3
97% of
287 eligible Patients
Post Discharge Continuing Care Plan Created Adults Age 18 - 64
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(See Quarterly Results)
This organization’s performance is similar to the target range/value.
100% 92% ----3 ----3
95% of
941 eligible Patients
Post Discharge Continuing Care Plan Created Older Adults Age 65 and Older
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(See Quarterly Results)
This organization’s performance is similar to the target range/value.
100% 87% ----3 ----3
95% of
169 eligible Patients
 
Post Discharge Continuing Care Plan Transmitted Overall Rate
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(See Quarterly Results)
This organization’s performance is similar to the target range/value.
100% 87% ----3 ----3
88% of
1398 eligible Patients
Post Discharge Continuing Care Plan Transmitted Children Age 1 - 12
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(No Quarterly Results are available)
Not displayed.
4
100% 91% ----3 ----3
----
Post Discharge Continuing Care Plan Transmitted Adolescents Age 13 - 17
Read More


(See Quarterly Results)
This organization’s performance is similar to the target range/value.
100% 90% ----3 ----3
92% of
287 eligible Patients
Post Discharge Continuing Care Plan Transmitted Adults Age 18 - 64
Read More


(See Quarterly Results)
This organization’s performance is similar to the target range/value.
100% 86% ----3 ----3
87% of
941 eligible Patients
Post Discharge Continuing Care Plan Transmitted Older Adults Age 65 and Older
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(See Quarterly Results)
This organization’s performance is similar to the target range/value.
100% 83% ----3 ----3
88% of
169 eligible Patients
 
Hours of Physical Restraint Use per 1000 Patient Hours - Overall Rate
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(See Quarterly Results)
This organization’s performance is above the target range/value.
N/A 0.5201 ----3 ----3
0.2542
(324 Total Hours in Restraint)
Hours of Physical Restraint Use Children Age 1 - 12
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(See Quarterly Results)
This organization achieved the best possible results.
N/A 0.3454 ----3 ----3
0.0000
(0 Total Hours in Restraint)
Hours of Physical Restraint Use Adolescents Age 13 - 17
Read More


(See Quarterly Results)
This organization’s performance is similar to the target range/value.
N/A 0.2295 ----3 ----3
0.2193
(22 Total Hours in Restraint)
Hours of Physical Restraint Use Adults Age 18 - 64
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(See Quarterly Results)
This organization’s performance is above the target range/value.
N/A 0.5652 ----3 ----3
0.2441
(242 Total Hours in Restraint)
Hours of Physical Restraint Use Older Adults Age 65 and Older
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(See Quarterly Results)
This organization’s performance is above the target range/value.
N/A 0.4783 ----3 ----3
0.3267
(61 Total Hours in Restraint)
 
Hours of Seclusion Use per 1000 Patient Hours - Overall Rate
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(See Quarterly Results)
This organization’s performance is above the target range/value.
N/A 0.3482 ----3 ----3
0.1942
(248 Total Hours in Seclusion)
Hours of Seclusion Use Children Age 1 - 12
Read More


(See Quarterly Results)
This organization achieved the best possible results.
N/A 0.6569 ----3 ----3
0.0000
(0 Total Hours in Seclusion)
Hours of Seclusion Use Adolescents Age 13 - 17
Read More


(See Quarterly Results)
This organization’s performance is above the target range/value.
N/A 0.2476 ----3 ----3
0.1148
(11 Total Hours in Seclusion)
Hours of Seclusion Use Adults Age 18 - 64
Read More


(See Quarterly Results)
This organization’s performance is above the target range/value.
N/A 0.3837 ----3 ----3
0.2372
(235 Total Hours in Seclusion)
Hours of Seclusion Use Older Adults Age 65 and Older
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(See Quarterly Results)
This organization’s performance is above the target range/value.
N/A 0.0748 ----3 ----3
0.0077
(1 Total Hours in Seclusion)
National Quality Forum The Joint Commission only reports measures endorsed by the National Quality Forum.  
* This information can also be viewed at www.hospitalcompare.hhs.gov.
---- Null value or data not displayed.

1 - The measure or measure set was not reported.
2 - The measure set does not have an overall result.
3 - The number is not enough for comparison purposes.
4 - The measure meets the Privacy Disclosure Threshold rule.
5 - The organization scored above 90% but was below most other organizations.
6 - The measure results are not statistically valid.
7 - The measure results are based on a sample of patients.
8 - The number of months with measure data is below the reporting requirement.
9 - The measure results are temporarily suppressed.
10 - Test Measure: a measure being evaluated for reliability of the individual data elements or awaiting National Quality Forum Endorsement.
11 - There were no eligible patients that met the denominator criteria.


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