Multidisciplinary Rounds July 14, 2014
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1 Multidisciplinary Rounds July 14, 2014
2 Board Certified Family Practice Full time practitioner until 2003 Peer Review Organization of NJ Physician Advisor (PA) since 1992, full time since 2003 Assoc. Director Medical Affairs Board Certified American Board of Quality Assurance & Utilization Review Physicians (Fellow) MHA University of Maryland (2014) Consultant Jim Hull Resource Management Group American College of Physician Advisors
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4 Definition: number of midnights Economic Considerations of LOS Quality Consideration of LOS Medicare LOS vs. Commercial LOS Throughput Considerations Readmission Considerations 2 Midnight Rule-now LOS more important!
5 Members: Floor Nurse, Nurse Manager, Physician Advisor, Social Worker, Case Manager, Physical Therapy, Respiratory Therapy, Visiting Nurse, Palliative Care Nurse, Nutrition, Pastoral Care Spend 1 minute or less per patient, per day, 5 days per week PA attendance
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7 Nurse Manager keeps flow of nurses going Floor nurse gives brief clinical picture focusing on IS/SI PA coordinates, listens for physician issues Social Work-Discharge planning, e.g. living situation, rehabs, long term care, social issues Case Manager-Utilization review, progression of care
8 Physical Therapy-rehab evaluation, moving patients after surgery Nutrition-prolonged NPO, swallowing issues, decubitus ulcers Respiratory Therapy: 0 2 dosage, nebulizer treatments, incentive spirometry Visiting Nurse-home care needs, 0 2, antibiotics Palliative/Pastoral Care: end of life issues, support for grim diagnosis Readmission Prevention
9 Must be made an administrative priority by CEO down CNO directs nurses to participate COO directs departments to participate and provides the tools to do their jobs (laptops, portable phones, etc.) CMO informs medical staff that this is a matter of good quality
10 50% avoidable days are due to hospital inefficiency Radiology delays, stress/echo delays, picc line delays, test result delays, weekend delays, OR delays PA must go meet with departments to improve patient flow
11 Physician Delays: afternoon or evening rounder, uses Dr. Slow as consultant, coverage groups, still practicing in the 80 s 50 % of avoidable days Readmission Prevention, use of transitional care
12 CENTRASTATE MEDICAL CENTER LOS COST COMPARISON BY PHYSICIAN VARIANCES EXCLUDING LOS > 30 AUG JAN 2011 FAMILY PRACTICE/ INTERNAL MEDICINE/ GERIATRICS TOTAL TOTAL ALOS ALOS TOTAL TOTAL TOTAL ALOS ALOS TOTAL TOTAL MEDICARE DAYS CASES MEDICARE VARIANCE COST DAYS CASES NON-CARE VARIANCE COST COST CMI MEDICARE MEDICARE MEDICARE MEDICARE NON-CARE NON-CARE NON-CARE NON-CARE FAM PRAC RESIDENCY , ,046-99, HOWELL PRIMARY CARE , ,011-52, FREEHOLD HOSPLST LLC 1, ,933 1, ,821-48, SHARMA,NIVEDITA , ,072-37, HAYNE/PETERS/PECK , ,648-37, TAYLORS MILLS FA MED , ,516-31, KATZ,HOWARD , ,674-30, HUSSAIN,ZAHID ,810-21, PATEL,KALPESHKUM , ,824-20, PATEL,JATINCHAND * MAJUMDAR,SHIKHA , ,320-15, MILLS,ORLANDO , ,150-13, YOUSSEF,MAHER A , ,847-12, RIJH-SINGHANI,SONIA , ,256-11, BALAR,DHIMANT , ,657-11, MANKARIOS,FARAG , , KRISHNA,SUNANDA , ,242-9, LOMBARDI & SHETTY , ,519-8, ELITE MEDICAL GROUP , , GHANEM,OSAMA ,501-5, SHENKER,BENNETT ,565-5, ALDAY,GERONIMA , ,550-5, SALCEDO,ELIZABETH , , WEISSMAN/KROLL , , ENG,KENNETH , ,775-3, CHATTERJEE,ABHIJIT , ,141-3, STERN,JULIE , ,092-3, FEINGOLD,MARC , ,481-3, RALPH MESSO DO ,092-3, LIQUORI,FRANCES , ,311-2, SOJKA,LESLIE W , ,078-2, CHERCIU,MUGUREL , ,199-2, RAYMOND,JOSHUA , KELTER,RICHARD COHEN,HOWARD , , CHEN,ROBERT ZUCKERBROD/AXELRAD , , FAM PRACT CEN JERS , ,170 1, KIM,MIAH , ,545 1,
13 Transparent data monthly Reward good guys Improvement comes from middle of the pack Stop calling offices for discharges-talk with docs as they round or speak through case manager. Use texting. Encrypted text programs preferred. Post best performers in physician lounge PA must live on floors talking to docs to be credible- know the cases!
14 Text them when a result comes back (HIPPA compliant) Mentor young physicians Leave notes in charts (pink cards) Insurance denials Gainshairing Link to Administration Have the back of the nurses, case managers when conflict arises Administration needs to know how much cash you saved them (ROI)
15 Admissions can be screened/reviewed in rounds Can look for admits that do not look like they will achieve 2 midnights or have IS to justify admit Can review observation cases for disposition Far more effective than remote chart review
16 MDR s are a short and long term solution to LOS Better Economic outcomes Better Quality outcomes Empowers the nurse Becomes a signature of the organization Increased importance with 2 midnight rule
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