What Are You Doing With the Data? Disclosures. Our System Goals Challenged All Departments - 3/5/2014

Transcription

1 What Are You Doing With the Data? Susan Weinstein, RN, BSN NCDR ICD Database Manager WellStar Health System Marietta,GA Disclosures Went to 2013 NCDR Conference Final Evaluation : I wrote, We need more examples of how others are using data, please! Here I stand! Be careful what you ask for. See YOU next year. 2 Goals Today: 1. You will have some useful ideas to take home. 2. This will be more interesting than web-surfing on your phone. Our System Goals Challenged All Departments - To Be the Best of the Best as defined by Nationally recognized metrics. In EP/ICD that includes: ACC/NCDR-ICD Metrics CMS Core Measures 1

2 How To Be The Best? New Processes Need New Tools Where Do I Start? The First 3 Steps 1. In God we trust. All others must bring data. W. Edwards Deming, statistician 2. The goal is to turn data into information, and information into insight. Carly Fiorina, former executive, president, and chair of Hewlett-Packard Co. 3..then, finally, insight into action. Susan Weinstein, NCDR ICD Database Manager Turning Data Into Information & Information Into Action Our Current Projects: Capturing complete data Guidelines Awareness & Documentation ACE/ARB/BB Rx or contraindications Antibiotics within 1 hour Beginning the process Joint Commission Disease Specific Certification for ICD using NCDR data MOC Requirements 2

3 Capturing Complete and Accurate Data No More Unspecified s Toughest elements to capture consistently were: 1. NYHA Functional Class 2. History of Heart Failure and Duration 3. Primary or Secondary Indications 4. Life expectancy > one year? Barriers to Change Understanding Relevance Getting on their radar Medicare requirement QO Modifier National Coverage Determination Maintenance of Certification National Clinical Trial Number Barriers to Change Need for understanding Relevance Getting on their radar Medicare requires participation in a Registry (QO Modifier) National Coverage Determination It s how we get paid Maintenance of Certification requirements Need for Education regarding definitions Cardiomyopathy with an EF of 15% is not Heart Failure When was the patient first diagnosed with symptomatic HF? Need for culture change EP physicians deferring to primary cardiologist especially re: meds Learning to Spell it Out ~ It s NOT always obvious why there s no ACE/ARB/BB 3

4 Barriers to Change Need for Education regarding definitions I can t code Heart Failure with Cardiomyopathy with an EF of 15% When was the patient first diagnosed with symptomatic HF? - Symptom Duration Barriers to Change Need for culture change EP physicians deferring to primary cardiologist especially re: meds Learning to Spell it Out ~ It s NOT always obvious why there s no ACE/ARB/BB Madit II or ScdHft Indications - helpful for Primary Prevention, only. Can t use to infer EF or NYHA. The Right Tool For the Job? Keeping it simple and quick 1 st st up: NYHA & Device Indication: 1) Ideal time to document is in clinic. (Too many variables) 2) Asked the question: Where did every ICD patient and every physician intersect every time? 3). In the EP lab and every EP procedure has a preliminary section of required documentation. 4

5 Required Information Before Starting Procedure Physician ASA Classification Date: 11/21/2013 Time: Physician ASA Classification Mallampati Class Fire Risk NYHA Functional Class Indication for Procedure This Information is recorded by the EP monitor person before every procedure: 8:32:56 AM Class IV-Patients with severe disease II-Visualization of the Soft palate,. 1pt Alcohol-based skin prep Class II Primary The Right Tool For the Job Next Up: Meeting Guidelines Needed to get all the information: 1. on one page 2. Required about a minute to complete 3. Would stay with the permanent chart A tool that would promote understanding of the guidelines in a brief format. NCDR Conference Posters are a Gold Mine! Big Shout out to: Jennifer Fleming, RN Atlantic Health System Morristown Medical Center for her NCDR Conference Poster, 2012 and For graciously sharing their tool. Thank you! 5

6 Our Tool Side 1 Physicians advised to complete Collects all difficult data points Requires circles or brief notations, only 35% 6

7 Is the Tool Working? When used, the physician s documentation provides the best and most accurate, reliable data. Where used consistently 10% improvement on Metric 12 Meeting our goal of top decile. Antibiotics Within One Hour This is a Core Measure linked to VBP. Drilldowns revealed correlation between anesthesia in the room and missed opportunities Focused attention via EP Director and Cardiac PIC EP staff have added Antibiotic and Time to timeout, including verbal & written verification of time given. 7

8 Information Into Action Who Owns the Data? We Are Developing A Process Improvement Team 1. The physicians 2. The APP s 3. The EP lab staff 4. Recovery unit staff 5. The data manager Joint Commission Disease Specific Certification-ICD Journey JC looks at the processes a facility has in place to treat, monitor, assess, and improve patient care. Using NCDR data to define, measure and document ongoing process improvement plans Turning Data Into Information & Information Into Action Our Current Projects: Capturing complete data and increasing Guidelines Awareness with our Quick Reference Guide and Hard Stops Documentation Antibiotics within 1 hour Time outs Beginning the process Joint Commission Disease Specific Certification for ICD using NCDR data MOC Requirements Physician driven projects 8

9 What Are You Doing With the Data? Looking forward to seeing your presentation next year! 9