Reducing GI Surgery Re-Admissions, While Increasing Patient Satisfaction D. Leigh Webb, DrPH, MPH, CTR WellStar Health System, Marietta, GA
Nothing to disclose Disclosures
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
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 14.77 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 readmissions within the first 30 days following surgery, was higher than the national average following GI Oncology surgeries
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, 2016 2. To decrease the direct cost of re-admissions by $50,000 by December 31, 2016
Process Map Patient receives AVS Patient goes home Patient receives call from customer service Complication? Yes Readmission if needed No
SIPOC Suppliers Inputs Process Outputs Customers Provider Input requirements and measures Start: Output requirements and measures Receiver Printer Documentation of understanding Patient/ Family EMR Nurse MD Nurse Patient/Family AVS Patient receives AVS Paper orders EMR EMR 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 Patient goes home Decrease HAI Insurance company EMR Employees Happy customer Patient/ Family HR Patient Perception of caring Customer Service dept Press Ganey Surgical date MD Surgical type Survey tool Patient receives call from Customer Service Unhappy customer Anyone patient/family talks to
Plant Fishbone Diagram People Process TMI at teaching session Patient re-admitted Waited until last minute Didn t follow AVS instructions No pre-adm education Lack of understanding Extra visit for patient Not a priority Fragmented services No process owner Specialization of professionals Complex surgeries CMS driven Resource allocation Complex diagnosis Cost quality of care Comorbidities Limited resources Ineffective gatekeeping policies 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 $145,355.40. Oncology surgeons felt re-admissions within first 30 days following surgery, was higher than the national 10 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
50% Results 45% 40% 35% Percentage of Patients Re-Admitted 30% 25% 20% 15% 10% 5% 0% Month
Direct Cost $50,000.00 $45,000.00 $40,000.00 $35,000.00 $30,000.00 $25,000.00 $20,000.00 $15,000.00 $10,000.00 $5,000.00 $- Results Direct Cost of Re-Admissions Month
Results Time Frame Re-Admission Rate Direct Cost Jan May 2015 14.77% $145,355.40 June December 2015 8.2% $71,017.33 CY 2016 5.3% $58,862.03 CY 2017 5.8% $102,484.00
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 preop 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
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