FHA HIIN Readmissions Peer Sharing Webinar: Improving Care Transitions through a Discharge Lounge July 24, 2018
Welcome & Overview How are we doing on Reducing Readmissions? Peer Sharing Presentation: Improving the Discharge Process Leslie Pollart, Director of Nursing for Memorial Regional Hospital Q&A / Group Discussion Next Meeting Today s Agenda
FHA Mission To Care Hospital Improvement Innovative Network (HIIN)
The Largest Quality Improvement Initiative in the WORLD!
Who is in the HRET HIIN? FHA Mission To Care: 93 Hospitals 5
Readmissions Regional Discussion Forums Opportunity to share challenges and explore strategies Themes Focus on Readmissions within 7 days Follow up appointments Patient engagement Challenging diagnoses Medication safety Discharge delays Hospital-SNF-Hospital transitions Palliative Care referrals
Readmissions 30 Day All Cause 12.0 10.0 8.0 Rate per 100 6.0 4.0 2.0 0.0 BL O-16 N-16 D-16 J-17 F-17 M-17 A-17 M-17 J-17 J-17 A-17 S-17 O-17 N-17 D-17 J-18 F-18 M-18 FL Rate 10.18 9.83 10.18 10.11 10.02 10.00 9.96 10.15 9.87 10.23 10.15 9.93 9.66 9.76 9.70 9.77 9.98 9.73 9.31 HRET HIIN Rate 8.82 8.51 8.66 8.48 8.82 8.87 8.45 8.73 8.78 8.35 8.84 8.68 8.40 8.71 8.68 8.36 8.83 8.44 7.78 # FL Rptg. 90 87 87 87 87 87 87 81 83 82 82 82 83 82 78 72 70 70 62 # HRET HIIN Rptg. 1,461 1,493 1,492 1,526 1,508 1,504 1,525 1,489 1,487 1,502 1,475 1,475 1,496 1,464 1,451 1,453 1,413 1,389 1,205 Effective date: July 20, 2018
Readmissions Medicare 16.0 14.0 Baseline = 13.59 12.0 Rate per 100 10.0 8.0 6.0 4.0 2.0 0.0 O-16 N-16 D-16 J-17 F-17 M-17 A-17 M-17 J-17 J-17 A-17 S-17 O-17 N-17 D-17 J-18 F-18 M-18 FL Rate 13.06 13.17 12.79 13.04 12.80 12.78 13.08 12.46 13.84 13.47 12.94 12.60 12.58 13.05 13.21 12.90 12.40 12.64 # FL Rptg. 79 79 80 79 79 78 75 76 76 76 76 76 75 70 66 64 64 59 Effective date: July 20, 2018
Readmissions Medicare 16.0 14.0 12.0 Rate per 100 10.0 8.0 6.0 4.0 2.0 0.0 BL O-16 N-16 D-16 J-17 F-17 M-17 A-17 M-17 J-17 J-17 A-17 S-17 O-17 N-17 D-17 J-18 F-18 M-18 FL Rate 13.59 13.06 13.17 12.79 13.04 12.80 12.78 13.08 12.46 13.84 13.47 12.94 12.60 12.58 13.05 13.21 12.90 12.40 12.64 HRET HIIN Rate 11.49 11.47 11.71 11.52 11.53 11.79 11.45 11.71 11.63 11.44 11.63 11.41 11.39 11.69 11.86 11.62 11.26 11.02 9.97 # FL Rptg. 70 79 79 80 79 79 78 75 76 76 76 76 76 75 70 66 64 64 59 # HRET HIIN Rptg. 1,165 1,340 1,338 1,367 1,361 1,358 1,374 1,339 1,337 1,354 1,328 1,325 1,340 1,316 1,287 1,295 1,260 1,224 1,048 Effective date: July 20, 2018
IMPROVING THE DC PROCESS Leslie Pollart, Director of Nursing Volume LOS Timeliness
History Opened in 1953 with 100 beds Three campuses, one license, 1,057 total beds: Memorial Regional Hospital (553 beds) Joe DiMaggio Children s Hospital (224 beds) Memorial Regional Hospital South (280 beds) Regional Tertiary and Quaternary Care Hospital One of only 7 state-approved Level 1 trauma centers (adults and pediatrics) Largest provider of emergency services in Broward County 1 Largest provider of acute care inpatient services in Broward County 1 Comprehensive Stroke Center Adult Heart Transplants 1 Source: Broward Regional Health Planning Council, One Year Ending December 2014
Services
DISCHARGE VOLUME: DAILY/HOURLY ANALYSIS
ADMISSION ORDERS BY TIME OF DAY
Discharge Timeliness: MD order time to Endpoint Goal is 120 minutes!
DISCHARGE BY DISPOSITION Against Medical Advice ALF Placement 14.21% Another Health Care Institution Not Defined Skilled Nursing Facility Expired 72.20% Home or Self Care Home-Health Care Svc Hospice/Home Psychiatric Hospital
MISSION STATEMENT Vacate the Bed
COURTESY LOUNGE
DC ORDER TO ENDPOINT ALL DISCHARGES Average Time 158 min
DISCHARGE ORDER TO END POINT (FROM DCL) Average Time 105 min
DC ORDER TO END POINT: 4 TH QUARTER 2016 OBSERVATION UNIT Average Time 93 min
DISCHARGE LOUNGE VOLUME 1250 1200 DCL Closed for Reno 1150 1100 1050 1000 950 Volume 900 850 800 750 700 650 600 550 500 Jan April May June July Aug Sept Oct Nov Dec Feb Mar April May June July Aug Sept Oct Nov Dec '17 Volume 769 847 879 839 954 952 1035 895 964 1108 1152 1191 1052 1082 1025 1003 1198 1117 1199 1099 1112
COURTESY LOUNGE UTILIZATION : HOME AND HOME HEALTH D/C JULY 2016 TO DECEMBER 2016 25
Average Time in DCL: April 2014 thru May 2015 70 60 61 50 40 30 51 44 41 40 31 41 50 52 46 51 47 46 55 20 10 0
Discharge Timeliness: Observation Unit
DISCHARGE LOUNGE STATISTICS 101 113 112 121 111 114 71 68 72 Median Order to DCL Median DCL to End 54 43 35 33 36 39 40 37 30 April May June July Aug Sept Oct Nov Dec
DC Lounge Utilization & Frequency of Purple Alerts 700 600 500 400 300 200 100 0 36 381 382 371 13 12 100 6 462 350 9 3 14 239 36 533 383 280 14 13 41 444 642 33 611 29 654 19 609 13 45 40 35 30 25 20 15 10 5 0 Month Total Purple Alerts
Discharge Courtesy Lounge Hours of Operation: Monday through Sunday 09am-2130 RN & PCA open lounge; then RN is added at 11am
TRANSITIONS OF CARE TEAM
TRANSITIONS OF CARE: DEFINITION Definition of Terms Transition of Care The movement of a patient from one setting of care (hospital, ambulatory primary care practice, ambulatory specialty care practice, long-term care, home health, rehabilitation facility) to another. Reference: CMS.gov
FOCUS Medication- Pharmacy review of medications while in hospital, post-discharge and access to medications. Increased utilization of concierge pharmacy. Disease education- Clinical support team available to assist patient in better understanding of disease process and treatment plan. Follow- up care- Case Management team instrumental in identifying at risk group upon admission and assisting in providing additional support to patient both during and after hospitalization.
CALL BACK SCHEDULE Day of Call Case Management Pharmacy Nursing 2 x 7 x 14 x 21 x 28 x
CONTACT CARDS
TOC TRACKER Call backs: Days 2, 5, 7, 10, 14, 21, & 28 Indicates DC to DC clinic
CALL BACK SCRIPTS BY TIME INTERVAL
EPIC CALL BACK DOCUMENTATION
ACUTE MYOCARDIAL INFARCTION
CHRONIC OBSTRUCTIVE PULMONARY DISEASE
HEART FAILURE
PNEUMONIA
TOTAL HIP/KNEE ARTHROPLASTY
AVERAGE TIME TO READMISSION (DAYS) 25 20 14-21 Days Highest Risk for Readmit 15 10 5 0 AMI COPD HF Pneumonia Hip/Knee Avg Time to Readmit (Days) 14.5 11.8 15.3 21.7 0
CALL BACK ATTEMPTS OCTOBER-DECEMBER 2017 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Day 7 Day 14 Day 28 Oct 100% 84% 93% Nov 100% 95% 98% Dec 100% 90% 87% Oct Nov Dec
CALL BACK CONTACTS OCTOBER-DECEMBER 2017 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Day 7 Day 14 Day 28 Oct 69% 50% 79% Nov 77% 60% 71% Dec 84% 55% 49% Oct Nov Dec
QUESTIONS?
Improving the Flow of Information - EDie ED as an Island ED as a Bridge PCP Post-Acute In-Patient ED is focused primarily on efficiency and is only concerned with acute care episode ED and hospital at large view as separate from the larger care continuum ED is intrinsically connected to entire healthcare enterprise and is focused on items beyond efficiency ED collaborates to help prevent readmissions, avoid preventable admissions, and promote care coordination
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