collaborative tools in healthcare
DESCRIPTION
Using Salesforce Chatter to improve post discharge follow upsTRANSCRIPT
Improving Post Discharge care
Dr. Sawad Thotathil| Vice President, Performance ImprovementNew England Inpatient Specialists
North Andover MA
The problem scenario when the project was initiated
Winchester hospital was trying to ensure post discharge follow up. This involved a floor RN calling up the practice
Problems faced
Time away from bedside. Each call could take 10 to 15 minutes
Practice staff could not immediately give appointments as they have to check with the providers.
Closing the loop through back and forth calls was not practical
Project Scope Goal : Improve post discharge patient care by ensuring discharged
patient follow up at the PCP office
Objective: Establish simple Facebook-Page-type asynchronous communication between hospitalist team and PCP offices to enable closed loop hand-off communication on discharges and appointments (of Hospitalist patients).
Project metrics This project involves ALL Patients having a designated PCP from one of
the 6 practices and are cared for by the NEIS hospitalist team at Winchester Hospital
Performance metrics looked at in this project
Of all patients, % of patients which were followed up by the PCP team soon after discharge; follow up is defined as a staff member from the practice acknowledges some action has been taken such as “informed MD”, “talked to patient”, “appointment given on date xxx”, “patient seen” etc.
Of all patients, % of patients given an appointment date
Average number of days between discharge date and appointment date
Project course Initiated Aug 2012
Practices enter the project over the next few months
Setting up involved –Obtaining agreement of the Practice leader, 1 or 2 sessions of training for practice staff (1 or 2 at each practice either RN ,medical assistant or NP)
Within a couple of months of setting up, this has moved from being a project to becoming the routine system of communication to fulfill the objectives
Why asynchronous group communication is better for Care coordination? Care coordination needs coordination between organizations as
diverse as senior services to specialist offices
Delays ,bottlenecks and lack of care (at the right time at the right moment) are mostly due to the inability to coordinate the decision making and actions of the different stakeholders.
The operating currency is Information
Depending on One-to-one communication to pass critical information between multiple stakeholders does not succeed because
This channel is only as strong as the weakest link in the chain
Different stakeholders work in different ‘time zones’ resulting in failure to connect
Benefits of Asynchronous communication The problem of the weakest link is overcome by using Broadcasting
methods in which if one person is unable or does not pick up and act on a piece of information, another concerned person will pick up on it
If people with different workflows and time conveniences need to connect consistently, they need to be able to leave an information packet to be picked up at the convenience of the other i.e. communicate asynchronously
Behavioral routines of Closing the loop on a request serve to reinforce communication links between persons/teams
Transactional collaboration Broadcasting from team to team
Quarter 3 2012
Quarter 4 2012
Quarter 1 2013
Quarter 2 2013
Quarter 3 2013
Quarter 4 2013
0%
20%
40%
60%
80%
100%
120%
Practice - BURTotal Patients Discharged to Practice = 312
Percentage Appt MadePercentage Followed Up
Quarter 3 2012
Quarter 4 2012
Quarter 1 2013
Quarter 2 2013
Quarter 3 2013
Quarter 4 2013
-
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2
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10
Practice - BURTotal Patients with Appt Made = 209
Average # of Days Between D/C & Appt
Quarter 4 2012
Quarter 1 2013
Quarter 2 2013
Quarter 3 2013
Quarter 4 2013
0%
20%
40%
60%
80%
100%
120%
Practice = MARKTotal Patients Discharged to Practice = 120
Percentage Appt MadePercentage Followed Up
Quarter 4 2012
Quarter 1 2013
Quarter 2 2013
Quarter 3 2013
Quarter 4 2013
0
2
4
6
8
10
12
14
16
Practice = MARKTotal Patients with Appt Made = 94
Average # of Days Between D/C & Appt
Quarter 3 2012
Quarter 4 2012
Quarter 1 2013
Quarter 2 2013
Quarter 3 2013
Quarter 4 2013
0%
20%
40%
60%
80%
100%
120%
Practice - TEWKTotal Patients Discharged to Practice = 266
Percentage Appt MadePercentage Followed Up
Quarter 3 2012
Quarter 4 2012
Quarter 1 2013
Quarter 2 2013
Quarter 3 2013
Quarter 4 2013
-
1
2
3
4
5
6
7
8
9
Practice - TEWKTotal Patients with Appt Made = 189
Average # of Days Between D/C & Appt
Quarter 4 2012
Quarter 1 2013
Quarter 2 2013
Quarter 3 2013
Quarter 4 2013
0%
10%
20%
30%
40%
50%
60%
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80%
90%
100%
Practice - WFPTotal Patients Discharged to Practice = 287
Percentage Appt MadePercentage Followed Up
Quarter 4 2012
Quarter 1 2013
Quarter 2 2013
Quarter 3 2013
Quarter 4 2013
-
2
4
6
8
10
12
14
Practice - WFPTotal Patients with Appt Made = 182
Average # of Days Between D/C & Appt
Quarter 4 2012
Quarter 1 2013
Quarter 2 2013
Quarter 3 2013
Quarter 4 2013
0%
20%
40%
60%
80%
100%
120%
Practice - WMWTotal Patients Discharged to Practice = 176
Percentage Appt MadePercentage Followed Up
Quarter 4 2012
Quarter 1 2013
Quarter 2 2013
Quarter 3 2013
Quarter 4 2013
-
10
20
30
40
50
60
Practice - WMWTotal Patients with Appt Made = 85
Average # of Days Between D/C & Appt
Quarter 4 2012
Quarter 1 2013
Quarter 2 2013
Quarter 3 2013
Quarter 4 2013
0%
20%
40%
60%
80%
100%
120%
Practice - WMWoTotal Patients Discharged to Practice = 434
Percentage Appt MadePercentage Followed Up
Quarter 4 2012
Quarter 1 2013
Quarter 2 2013
Quarter 3 2013
Quarter 4 2013
-
2
4
6
8
10
12
14
16
18
Practice - WMWoTotal Patients with Appt Made = 161
Average # of Days Between D/C & Appt
What technology was used? Salesforce.com platform
This platform has a collaborative tool called Chatter that you saw in the screenshot
Beyond this project, we have gone on to use Chatter for our group’s Nursing home providers (for internal use at this point)
It is possible to use the same platform for virtual care teams focused on individual patients and even get patients communicating
