Davies Case StudyVehicles for Communication

August 2018

VCU Health’s Vision by DesignLynn Goodloe, MS, RN, NE-BC

Director of Patient Flow, Telepage, Service Response, Communications and Emergency Management

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Vision by Design provides pathways to preserve, sustain and advance our mission and elevates us to be among the premier academic health systems in the nation. One of the pathways

specifically challenges us to deepen our operational excellence and organizational effectiveness by optimizing patient flow so we can care for those who need us, when they

need us, where they need us and in the most appropriate manner.

Vision by Design – Throughput and Capacity

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Inpatient Hospital Stay

Four Components of Efficient Care

Why not open more beds?

Opening more beds, without fixing our processes, would immediately fill the beds and we would still be needing more inpatient space to accommodate our patients.

VCU Health had ZERO beds that could be converted into inpatient beds.

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VCU Health and TeleTrackingSharon Bednar MSN, RN, CEN, LSSGB

Performance Improvement Coordinator

VCU Health and TeleTracking

Local Problem:

Ineffective Communication: Potential to have a negative impact on the number of patient days for inpatients admitted to the acute care setting.

Goal: Improving communication among providers, patients, and families may improve the length of stay while improving patient satisfaction, safety and quality of care.

Strategies to Engage Team Members

IncreasedEngagement

Focus on Safety

Reduce paper processes

Make it meaningful to

teams

Reduce phone call

interruptions

Increase transparency

Layered communication

Lessons Learned

Realization

Change in culture

More effective

education plan

Needed clinicians’ guidance

More interface support

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Care Progression IndicatorsSharon Bednar MSN, RN, CEN, LSSGB

Performance Improvement Coordinator

Care Progression IndicatorsDocumented by the care teams to show progress to those patients that need their services. Used as a communication tool to provide real-time information.

Care Progression Indicators

Status Description Icon Recommendation New information that needs to be acknowledged or acted upon.

In Progress The patient and the appropriate therapist or caregiver are in the process of completing the care type, but it is not finished.

Completed The patient and the appropriate therapist or caregiver have finished the care type.

Delayed If the progress of the care type cannot continue at this time, select a reason from the Delay Reason list.

CPI: Communication between groups

Additional information:• Care Coordination• Occupational Therapy• Physical Therapy

Discharge Pharmacy

1. Red pill: Prescriptions sent to Pharmacy 2. Yellow pill: Pharmacist is filling prescriptions3. Green pill: Prescription filled. 4-digit code to release medications from the

tube station automated4. Alert icon: Delay was noted

Diagnosis-Related Group LOS

• DRG is a statistical system of classification • Length of stay generated by the Clinical Documentation Improvement

Department (CDI)• Interfaced into TeleTracking from the 3M 360 software

3M 360 ->TeleTracking

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Anticipated Day of DischargeGeorgia McIntosh, MD

Associate Professor, Hospital MedicineQuality Director for Internal Medicine Residency Program

ADD and TCRs

• Transitional Care Rounds (TCR) evolved o Focus on transition

• TCR structure impacted ADD successo Care Coordination

prompts ADD updates• Provider satisfier

o Increased communication

o Increased patient safety• Patient satisfier

o Increased communication on the patient whiteboard

ADD – How it works

Automated Pending Discharges

• Increase Pending Discharge communication across the organization

• TeleTracking is set to automatically update a patient’s status to a Pending Discharge at midnight on the Projected Day of Discharge.

• To avoid communicating a false Pending Discharge, the Projected Discharge Date must be kept as accurate as possible.

Unit View

Automated Pending Discharges

Throughput Administrator View

ADD Data

0

5

10

15

20

25

0%

10%

20%

30%

40%

50%

60%

Aug2017

Sep2017

Oct2017

Nov2017

Dec2017

Jan2018

Feb2018

Mar2018

Apr2018

May2018

Jun2018

July2018

Pend

ing

Disc

harg

e to

Disc

harg

e Du

ratio

n

DbN

and

Pend

ing

Disc

harg

e Co

mpl

ianc

e

Capacity Management

Discharge % by 12:00 % Pending Discharge Compliance

Pending Discharge to Discharge Duration Average in Hours Linear (Discharge % by 12:00)

DRG Added

ADDAdded

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Important Message from MedicareCynthia Mathews, MS, BSN, RN

Department of Care Coordination

Important Message from Medicare (IMM): Problems

• Problem- Not in compliance with IMM regulation.

• Problem- Unable to effectively communicate the need for the delivery of an IMM.

• Problem- IMM intent not met with “discharge pager” process.

Updating the IMM Delivery Process

Phase I – Setting the foundation

Culture changeWaiting for technology

Phase II – Solidified workflow

ADD adoptedSoftware build completeWaiting for build/test/approval of interface

Phase III – Go-live

Interface fully functional

Three phased approach:

IMM – How it works

• Medicare/Medicare Managed Payer triggers an M in the CPI column

• Care Coordination Assistant monitors ADD• Has IMM signed between 1-2 days of discharge• Updates IDX with date signed• Interfaces to TeleTracking and triggers an M in CPI column

IMM – How it works

• Triggers another message after 2 days, switching back to an M in the CPI column

IMM – How it works

IMM Compliance relies on ADD• §482.13 Condition of participation: Patient's rights. A hospital must protect and

promote each patient's rights. Noncompliance with this requirement places the hospital at risk of termination from the Medicare program.

81%84%

94% 92%88%

94% 92% 92% 92% 90% 90% 92% 93%96%

43%39%

49% 49% 51% 52% 54%50% 48%

45%49%

46% 45%40%

0%

20%

40%

60%

80%

100%

1/29 to2/23

Manualwithout

technology

3/5 to 4/22Manual

withtechnology

6/18 to6/24

Integrated

6/25 to 7/1Integrated

7/2 to 7/8Integrated

7/9 to 7/15Integrated

7/16 to7/22

Integrated

7/23 to7/29

Integrated

7/30 to 8/5Integrated

8/6 to 8/12Integrated

8/13 to8/19

Integrated

8/20 to8/26

Integrated

8/27 to 9/2Integrated

9/3 to 9/9Integrated

Tota

l Com

plia

nce

IMM Compliance

Total Compliance With Intent Baseline Total Baseline Intent

Return on Investment and

Accomplishments

Sharon Bednar MSN, RN, CEN, LSSGB Performance Improvement Coordinator

Return on Investment20% reduction in Lost Bed Time or 96,215 minutes

$112,950

$344,487

$195,006

$0

$50,000

$100,000

$150,000

$200,000

$250,000

$300,000

$350,000

$400,000

Capital Costs Yearly Operational Costs FY18 Lost Bed Time Savings

ROI

Return on Investment *Teams working together with improved communication

to provide patient-centered care

Roadmap to Luminary Site

Luminary Site

End user buy-in

Executive engagement

Innovation

Integration

Data driven

Optimization

Provides latest industry news and analysis

Monthly newsletter for VCU Health team members

Quarterly newsletter containing the latest industry

insights

Multiple Reference Calls & Site Visits

Thank you.

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