thequalitypost in this issue Get Out of Your Comfort Zone Edward Tufte s Principles for Effective Presentations Get Out of Your Comfort Zone

Transcription

1 thequalitypost Edward Tufte s Principles for Effective Presentations Get Out of Your Comfort Zone Multidiciplinary Care for COPD Going Above and Beyond Division Incentive Metrics Monthly Quality Improvement Newsletter for the Division of Hospital Medicine April 2014 Issue 40 in this issue Greetings from Michelle and Sasha QUALITY IMPROVEMENT DIVISION OF HOSPITAL MEDICINE Welcome to the 40 th edition of The Quality Post. In this issue, we feature a piece on effective presentations, a Going Above and Beyond story, and highlight the COPD transitions program. Edward Tufte s Principles for Effective Presentations It is no secret that giving a good talk can be challenging. The good news is that it is also highly coachable. According to Edward Tufte, an expert in informational graphics and pioneer in the field of data visualization, the success of presentations ultimately depends on three key elements: quality, relevance, and integrity. Here are some of Tufte s top tips on effective presentations: Before you begin preparing your talk ask yourself if you have an idea worth sharing, and if it is something you are genuinely passionate about. If not, decline the opportunity. As you prepare your talk, begin by addressing the problem, identifying who cares about it, and your solution. If you are presenting complicated material, think about breaking it down for your audience by starting with the particular, going to the grand principle, and then returning to the particular (PGP). Before the presentation, practicing intensely is essential. Consider video-taping yourself to see where you may be able to improve. Plan your delivery and think about if there are parts of your speech you think are worth memorizing word for word. Work on your stage presence, but remember that your authenticity and story matter more than whether you re visibly nervous. On the day of, Tufte recommends showing up early and finishing early - something good is bound to happen. While giving disclaimers can be tempting, avoid apologizing for being nervous. Knowing your audience and treating them as intelligent is key. Another helpful tip is to consider giving everyone in your audience a piece of paper. This says, I want to leave traces when I give presentations. Remember that presentations ultimately rise and fall on the passion of the speaker, and the quality, relevance, and integrity of the material. For more tips visit: Get Out of Your Comfort Zone Moving beyond our comfort zones is how we can best learn and grow. To develop the courage to take a leap, and the skill and ability to actually pull it off: Understand what s in it for you to motivate yourself. Brainstorm how working on this tough behavior networking, perhaps, or public speaking can advance your career or help you reach other goals. Then, customize a plan to take control of a situation instead of being overwhelmed by it. If, for example, you re an introvert who dreads networking events, instead of feeling pressured to meet everyone, focus on a few people and actually try to get to know them, or aim to make initial contacts with the goal of following up in a more comfortable setting. Adapted from Get Out of Your Comfort Zone: A Guide for the Terrified by Andy Molinsky.

2 Multidiciplinary Care for COPD Why the work on COPD? COPD patients are at high risk for readmissions Many other hospitals are creating COPD pathways to standardize care Requires a multi-disciplinary team across the continuum of care from the inpatient to the outpatient setting New Regulations for COPD Readmissions According to the Centers for Medicare and Medicaid Services (CMS), historically about one in five Medicare patients discharged from the hospital are readmitted within 30 days. As part of the Affordable Care Act, the Medicare Hospital Readmissions Reduction Program (HRRP) provides a financial incentive to hospitals to lower readmission rates. Currently CMS imposes financial penalties to hospitals with excess readmissions for AMI, HF, and PN. CMS is expanding the list of applicable conditions in late 2014 to include patients admitted for acute exacerbation of COPD. In FY2013, UCSF s COPD 30-Day readmission rate was 24%. Nationally, COPD readmission rates range from 16-29% so we have some room for improvement. COPD Education RT will perform COPD teaching and MDI instruction for all patients with COPD! Trigger teaching either by: Ordering nebs Using the MDI teaching order

3 Multidiciplinary Care for COPD Inpatient Pulmonary Consults Ever wonder if COPD patients get pulmonary consultations? YES! Indications include: Admission to the ICU for COPD exacerbation New diagnosis of COPD / Diagnosis not established by PFTs >2 previous admissions in the last 6 months for COPD Referral to Pulmonary Rehab (covered for Medicare patients) Referral to Quality of Life clinic Getting Ready for Discharge: O2 documentation What you may not know For your Medicare patients, Maureen Carroll & Eileen Brinker will prompt the rest of the bundle: PT referral (function) Nutrition Home Health referral (RN/PT) Links to PCP Other outpatient programs

4 Multidiciplinary Care for COPD Your patients are ready for discharge...now what? What will be different when your patients go home? A greater understanding of COPD flares, self management and support PT to teach patient how to cope with exertion Talk about coordination with Home Care and other outpatient resources SF Transitional Care Program Funded by CMS, this program covers Medicare beneficiaries who are SF residents and 65 and older. The aim is to: Help eligible patients to transition safely from hospital to home Reduce unnecessary acute hospital readmissions Services include: Nutrition/Meals Transportation Home Care Follow-up Medical Appts Pulmonary Clinics: COPD General Pulmonary Clinic Parnassus MZ Referral through APEX Please contact primary pulmonary provider Educational Opportunity Breathing Workshop Support Group for Education Pulmonary Rehab Quality of Life Clinic Interdisciplinary team care focus on PC APEX referral to MZ Exercise and education for patients with lung dz Mod/severe obstruction or restriction + sxs Need OP pulm consult first o Insurance Coverage: Medicare Referral in APEX for MZ Pulm Second Thursdays of each month 11:00am-12:00pm Mt Zion Hospital Conference Room H3805 Your patients will learn how to live better with COPD, asthma and other lung diseases. Family members and caregivers are welcome to attend. Meetings are free. Facilitators: DorAnne Donesky, PhD, ANP-BC and Brenda Gallegos, RCP Special thanks to the COPD team: Maureen Carroll, Eileen Brinker, Brian Daniel, Michelle Milic, DorAnne Donesky.

5 Going Above and Beyond In this series we feature stories about individuals who have gone above and beyond for patients and families or improved the experience of providers/staff. Every time Stephanie Rennke is on service she invites her team to identify a patient to do a home/social visit during that month. Over the past 7 years she has done about 20 visits to several homes, group homes and SNFs/hospices including the Jewish Home, Laguna Honda, Kentfield, and Tunnell. A few weeks ago her team visited a patient at Zen Hospice that they had recently discharged. The patient had been admitted from home hospice with somnolence from sepsis/uti and had requested inpatient hospice. The team coordinated care with the patient s outpatient primary care provider. It is a great opportunity and learning experience for the interns, residents and medical students to visit with a patient/family following discharge. -Stephanie When visiting the patient, they were also able to tour the facility and meet the covering nurse and one of the many volunteers. From left to right: Jake Natalini, Ashwin Murthy, Sara Sani, Mark Lum Another one of Stephanie s teams visited Zen Hospice last month. They brought their patient an orchid. It was an amazing experience and one I will never forget. The nurse at Zen commented that the visit was extremely meaningful to patient and her family.

6 Division Incentive Metric Performance Decrease the percentage of patients on telemetry until discharge (with LOS > 48hrs) from 44% to 37% î 6 of 12 months FY 2013 Baseline July Aug Sept Oct Nov Dec Jan Feb Mar 44% 58% 50% 45% 32% 34% 39% 29% 15% 39% 50% 30% 10% Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec Jan Feb Mar FY2013 FY 2014 % with telemetry at discharge (LOS>48 hrs) Improve Blood Utilization by decreasing units of blood transfused for a Hbg 8.0 by from 30% to 25% 6 of 12 months FY 2013 Baseline July Aug Sept Oct Nov Dec Jan Feb Mar 30% 19% 18% 17% 12% 9% 7% 11% 14% 5% Achieve HCAHPS Communication with Doctors Top Box score above 80% î 6 of 12 months FY 2013 Baseline July Aug Sept Oct Nov Dec Jan 75.6% 80% 79% 74% 60% 86% 71% 67% Achieve 20% of Hospital Medicine Discharges by noon ì 3 of 12 months FY 2013 Baseline July Aug Sept Oct Nov Dec Jan Feb Mar Apr 8% 12% 10% 13% 15% 17% 11% 16% 14% 17% 24% 29% 21% 13% 5% Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec Jan Feb Mar Apr FY2013 FY 2014 % discharged by noon Goal Answer greater than 90% CDI Nurse Queries ì 9 of 12 months FY 2013 Baseline July Aug Sept Oct Nov Dec Jan Feb Mar 86% 93% 94% 96% 91% 94% 92% 88% 95% 92%