fha hiin readmissions peer sharing webinar: improving …jul 24, 2018  · transition of care –...

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 CareHospital Improvement

Innovative Network (HIIN)

The Largest Quality Improvement Initiative in the WORLD!

5

FHA Mission To Care:

93 Hospitals

Who is in the HRET HIIN?

• 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 Regional Discussion Forums

Readmissions – 30 Day All Cause

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 9.31HRET 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

0.0

2.0

4.0

6.0

8.0

10.0

12.0

Rate

per

100

Effective date: July 20, 2018

Readmissions – Medicare

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-18FL 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

0.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

16.0

Rate

per

100

Effective date: July 20, 2018

Baseline = 13.59

Readmissions – Medicare

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 12.64HRET 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

0.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

16.0

Rate

per

100

Effective date: July 20, 2018

Leslie Pollart, Director of Nursing

IMPROVING THE DC PROCESS

Timeliness

LOS

Volume

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 County1

• Largest provider of acute care inpatient services in Broward County1

• 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

72.20%

14.21%

Against Medical Advice

ALF Placement

Another Health CareInstitution Not DefinedSkilled Nursing Facility

Expired

Home or Self Care

Home-Health Care Svc

Hospice/Home

Psychiatric Hospital

“Vacate the Bed”

MISSION STATEMENT

COURTESY LOUNGE

DC ORDER TO ENDPOINTALL DISCHARGES

Average Time 158 min

DISCHARGE ORDER TO END POINT (FROM DCL)

Average Time 105 min

DC ORDER TO END POINT: 4TH QUARTER 2016OBSERVATION UNIT

Average Time 93 min

DISCHARGE LOUNGE VOLUME

April May June July Aug Sept Oct Nov Dec Jan'17 Feb Mar April May June July Aug Sept Oct Nov Dec

Volume 769 847 879 839 954 952 1035 895 964 1108 1152 1191 1052 1082 1025 1003 1198 1117 1199 1099 1112

500

550

600

650

700

750

800

850

900

950

1000

1050

1100

1150

1200

1250

Volu

me

DCL Closed for Reno

COURTESY LOUNGE UTILIZATION :HOME AND HOME HEALTH D/C

JULY 2016 TO DECEMBER 2016

25

Average Time in DCL: April 2014 thru May 2015

0

10

20

30

40

50

60

70

51

4441 40

31

41

5052

46

51

61

47 46

55

Discharge Timeliness: Observation Unit

DISCHARGE LOUNGE STATISTICS

April May June July Aug Sept Oct Nov Dec

5443 35 33 36 39

40 37 30

101113 112 121 111 114

71 68 72

Median Order to DCLMedian DCL to End

DC Lounge Utilization & Frequency of Purple Alerts

100

381 382 371

462

350

239

280

383

533

444

642611

654609

36

13 12

63

9

14

13

14

36

41

33

29

19

13

0

5

10

15

20

25

30

35

40

45

0

100

200

300

400

500

600

700

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 x7 x14 x21 x28 x

CONTACT CARDS

Call backs: Days 2, 5, 7, 10, 14, 21, & 28

TOC TRACKER

Indicates DC toDC 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)

AMI COPD HF Pneumonia Hip/KneeAvg Time to Readmit (Days) 14.5 11.8 15.3 21.7 0

0

5

10

15

20

25

14-21 Days

Highest Risk for Readmit

CALL BACK ATTEMPTSOCTOBER-DECEMBER 2017

Day 7 Day 14 Day 28Oct 100% 84% 93%Nov 100% 95% 98%Dec 100% 90% 87%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Oct Nov Dec

CALL BACK CONTACTSOCTOBER-DECEMBER 2017

Day 7 Day 14 Day 28Oct 69% 50% 79%Nov 77% 60% 71%Dec 84% 55% 49%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Oct Nov Dec

QUESTIONS?

Improving the Flow of Information - EDie

• 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 as an Island

• 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

ED as a Bridge

PCP Post-Acute

In-Patient

https://fhaawards.secure-platform.com/a/

Upcoming Events

• EDie Lunch & Learn Meeting (July 26 in Hollywood, FL)– Register: http://www.cvent.com/d/tgqdch

• Readmissions Sepsis Fishbowl Webinar Series: Part 5(Aug. 7 @ 12-1pm ET)– Register: http://hret.adobeconnect.com/readmissions-fishbowl-series-

part5/event/registration.html

• FHA Readmissions Stakeholder Virtual Meeting #4(Oct. 18 @ 12-1pm ET)– Register: https://cc.readytalk.com/r/njcwbouycn64&eom

– Email HIIN@fha.org to request a topic for discussion

We are here to help!

HIIN@fha.org407-841-6230

Contact Us