Financial Disclosure. Learning Objectives. Reducing GI Surgery Re-Admissions, While Increasing Patient Satisfaction

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1 Reducing GI Surgery Re-Admissions, While Increasing Patient Satisfaction Michelle Guibault, BSN, BS, RN Co-Author: D. Leigh Webb, MPH, CTR WellStar Health System, Marietta, GA Nothing to disclose Financial Disclosure Learning Objectives Identify the value of consistent messaging to inform patients of post-operative information and reinforcement through the continuum of care List two interventions initiated by Nurse Navigators to limit re-admissions Identify the financial impact of reducing re-admission rates

2 Background The Surgical Oncologists at WellStar Health System noticed an increase in GI Oncology Surgical re-admissions. Our re-admission rate was 13 percent, which is slightly higher than the national benchmark average of 12 percent Project Approach define measure analyze improve control Problem Statement The re-admission rate for 5S for GI Oncology surgeries January-June 1, 2015 was percent, which exceeds the national re-admission threshold of 12 percent Total direct cost for all of the re-admissions for the same time period was $145,355 Oncology surgeons felt that the number of re-admissions within the first 30 days following surgery, was higher than the national average following GI Oncology surgeries

3 Beginning January 1, 2016 Strategic Goals 1. To decrease re-admission rate for GI Oncology surgeries on 5 South to less than 10 percent by December 31, To decrease the direct cost of re-admissions by $50,000 by December 31, 2016 Process Map SIPOC Suppliers Inputs Process Outputs Customers Input requirements and Output requirements Provider measures and measures Receiver Start: Documentation of Printer understanding Patient/ Family Nurse MD Nurse Patient/Family AVS Patient receives AVS Paper orders Discharge order Empty Bed Next patient MD Physical criteria LOS/ DRG $ MD Care Coordinator Nurse Discharge nurse Hospital Patient/ Family WS Staff Home Other patients Return of function Discharge destination Decrease HAI Insurance company Patient goes home Employees Happy customer Patient/ Family HR Patient Perception of caring Customer Service dept Surgical date MD Surgical type Anyone patient/family Press Ganey Survey tool Unhappy customer talks to Patient receives call from Customer Service

4 People Patient re-admitted Didn t follow AVS instructions Lack of understanding Not a priority Plant Fishbone Diagram Process Specialization of professionals Complex surgeries Complex diagnosis Comorbidities TMI at teaching session Waited until last minute No pre-adm education Extra visit for patient Fragmented services No process owner CMS driven Resource allocation Cost quality of care Limited resources Ineffective gatekeeping policies 10 Policy The re-admission rate for GI Oncology Surgeries Jan-June, 2015 was 14.77%, exceeding national readmission threshold 12%. Total direct cost for all of the re-admissions for the same time period was $145, Oncology surgeons felt re-admissions within first 30 days following surgery, was higher than the national average following GI Oncology surgeries. Metrics There was consensus among the team that the data collection process would be the focus of the project A data collection plan was created and executed to include the following primary metrics: 1. Percentage of GI Oncology Surgical patients re-admitted with a post-operative complication within 30 days of the surgical discharge 2. Direct cost of the in-patient admission stay for the readmission visit Analysis During the brainstorming session, the team clarified that the appropriate collection of data would be measured by the percentage of patients who were re-admitted following a GI Oncology surgery for a direct surgical post-operative complication The team determined it was important to capture the amount of the direct cost for the admission for these patients, which is not reimbursable by insurance companies/cms

5 Direct Cost Percentage of Patients Re-Admitted Results 50% GI Oncology Re-Admissions 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% Month Results Direct Cost of Re-Admissions $50, $45, $40, $35, $30, $25, $20, $15, $10, $5, $- Month Results Time Frame Re-admission Rate Direct cost Jan-May % $145, June March % $128, April 2016 March 8.2% $99, (Outlier: 44,456.00) $54,566

6 Sustaining Results There were four proposed expected deliverables: 1. A system for increasing the frequency of phone calls to the patients following surgery by the physician office staff 2. Post-surgical zones document given at surgical discharge to educate patients on symptoms to watch for and when to notify the physician or emergency care Sustaining Results 3. Develop an education booklet in conjunction with a class that explains the pre-op instructions, what will happen during the hospital stay, and what symptoms to look for after discharge. An insert of an illustration of the specific surgery will be included for each patient with a personalized instruction pre-op class by the Nurse Navigator. Every patient is provided with a 27 oz. infuser water bottle to encourage hydration following surgery 4. Develop an individualized pre/post-op class based upon the patient's surgical procedure to be facilitated by the Nurse Navigator Barriers: Overcoming Barriers 1. Developing education material for the education booklet that was appropriate for patients and met copyright license agreements 2. Gaining support from physicians to require patients to attend the pre/post-op education class with the Nurse Navigator

7 Return on Investment Time Frame Direct Cost Direct Cost Jan May 2015 $145, June March 2016 $128, ($17,033) April 2016 March $99, ($46,333) 2017 Future Considerations The education classes have proven to be successful interventions, not only clinically but patients have expressed satisfaction with the classes Other disease sites for complicated surgeries are employing this process Patient Comments I was truly prepared for everything you said was going to happen When I woke up in ICU, I knew what everything attached to me was and why I needed it. I was not afraid since you had explained it all during my class Thank you so much, you made this cancer surgery a lot less scary for me and my family Between the class and having you come check on me in the hospital every day after surgery meant the world to me