ty cobb regional medical center reducing readmissions

Ty Cobb Regional Medical CenterReducing Readmissions

DEFINE

• Scope – Decrease 30 day readmission rate by

20%

• Project charter completed and approved

• Team members: Nursing, Case Management, Utilization Review

Charter discussion

MEASURE

• Line chart, Histogram, Xbar and R chart data reviewed by team members

• Process in control but not what we wanted

• Process Flow Mapping discussed

• Map completed

Initial Data

Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 Jan-12 Feb-12 Mar-12 Apr-12 May-12 Jun-12 Jul-120

0.01

0.02

0.03

0.04

0.05

0.06

0.07

0.08

Readmission Rate

RateLinear (Rate)

Process Map

ANALYZE

• “Sticky note” brainstorming• Process map was separated into sections: Admission, Inpatient Care, Day of Discharge

and Post Discharge• Each member moved from chart to chart• 52 thoughts added to flow map• Developed a list of improvement priorities

Sticky note exerciseDifferent map sections were placed around the room. Each team member was given a pen and a sticky note pad. They had 5 minutes to spend at each station writing as many suggestions or concerns as they could.

Before and After

IMPROVE/IMPLEMENT

• A problem list was developed and prioritized• Specific task list was made• Department involvement for each task was

delineated using RASCIN chart

Task List

• Combine Readmission Risk Assessment and Case Management Assessment

• Provide in-service to Nursing staff on patient education techniques and use of “Teach-Back” method

• Create e-forms for documentation • Concentrate post-discharge calls on “high risk”

patients• Better utilization of Home Health Care

RASCIN

R A S C I N

Combine Risk Assessment and Social Services Assessment

and implement

Case Management

Chief Nursing Officer None None None

Educate Nursing Staff on Teach Back for Patient Education

Medical Nurse Manager

Chief Nursing Officer HEN Resources Nursing None

Develop eforms for education

documentationMedical Nurse

ManagerChief Nursing

OfficerClinical IT/

HEN Resources Physicians None

Concentrate discharge calls to high risk

patientsCase

ManagementChief Nursing

Officer Utilization Review None None

Work with Home Health agencies to provide adequate resources at home

Case Management

Chief Nursing Officer

Home Health Agencies

None None

Readmission Risk Assessment

• A “home needs” screening is completed on each patient on admission

• Any positive screen is referred to Case Management and an in-depth assessment is performed

• We simply added questions to that assessment that will determine risk of readmission

• High risk patients receive a detailed post discharge call

Teach Back

• Teach back is a method of education assessment that requires the patient to repeat back the instructions in their own words

• If the patient’s description differs from what was taught, re-education can occur at that time

Post Discharge Calls

• Post discharge calls are completed by Utilization Review staff a few days after patient discharge.

• Patients are contacted at home to see how they are progressing and to discuss medications, follow up appointments

• Any problems noted are sent to Case Management for resolution

Home Health Care

• Our overall goal is for each high risk patient to be evaluated for Home Health Care and to be referred if they could benefit from services

Home Health Utilization

Jul-12 Aug-12 Sep-12 Oct-120

2

4

6

8

10

12

14

16

18

% of Discharged Patients Utilizing Home Health

% Home Health

Home Health Benefits

• Reinforcement of hospital discharge information

• Periodic physical assessments to prevent disease from progressing to hospitalization level

• Patients can remain at home in familiar surroundings and still receive the care they need

Success!!!

• 30 day Readmission Rate dropped from 0.0352 to 0.0128

• Decrease of 63.6%

• Projected Financial loss prevention: $1,166,690.26

Latest Data

Nov-11 Dec-11 Jan-12 Feb-12 Mar-12 Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-120

0.01

0.02

0.03

0.04

0.05

0.06

0.07

0.08

Readmission Rate

RateLinear (Rate)

CONTROL

• Continue to evaluate control charts

• Policy development to standardize the discharge process

Thank you!!

Tina Thomas RN

Ty Cobb Regional Medical CenterLavonia, Georgia

tina.thomas@tycobbhealthcare.com