family medicine healthnet inpatient service quality report and unit dashboard: bmc e6w quest:...

Family Medicine HealthNet

Inpatient ServiceQUALITY REPORT AND UNIT DASHBOARD: BMC E6W

QUEST: (QUALITY, EFFICIENCY, SATISFACTION AND TOTAL REVENUE)

October 03, 2014

Leadership Team Christopher Manasseh, MD

Assistant ProfessorVice Chair for Inpatient and Hospital Services

Aram Kaligian, MDAssistant ProfessorAssistant Inpatient Director

Jonathan Bunker, BSN, RNNurse Manager

Eileen Mullaney, RNRN Care Manager

Charlotte Cuneo, MSN, RN, CCAPClinical Nurse Educator

_______________________________________

Toyin Ajayi, MDHospitalist Medical DirectorDirector of Transitional MedicineCommonwealth Care Alliance

Ted ConstanChief Administrative Officer,Department of Family Medicine

Erica Cuevas, MPHAdministrative Coordinator

Gwyneth Jones, MBAAdministrative Manager

Brian Jack, MDProfessorChair, Boston University Department of Family MedicineChief, Boston Medical Center Department of Family Medicine

Jessica Martin, MA, MPHProgram Director

http://profiles.bu.edu/Christopher.Manasseh

http://profiles.bu.edu/Aram.Kaligian

http://profiles.bu.edu/Brian.Jack

IntroductionThis is a Quality Report describing the activity of the Family Medicine - Boston Health Net (FM-HN) Inpatient Service located on 6W of BMC’s East Newton Campus. The purpose for this Dashboard is to document and share the quality of the service with senior leaders and other constituentsFM-HN service accepts admissions from the family medicine practices at BMC and the CHCs and from the Boston Community Health Group (BCMG) which cares for high risk frail elders and disabled/homebound patients in our communities. As we continue with rapid PDSA (Plan-Do- Study- Act) cycles of improvement, and show improvement -- some graphic elements are dropped and are replaced by other priorities.

Introduction

These reports show areas in which we are doing well – and not so well – but that through this process we hope to continuously improve.

The idea for collecting these data metrics emanated from the concepts of teamwork and the desire to provide high quality services among the partners.

To begin, we organized a weekly meeting among the stakeholders designed to define the mission and the members of the team and to identify clear objectives that we would try to achieve.

The principles of collaboration and objectives for the inpatient team are listed on a poster that hangs in the entry of the unit (shown on the next slide).

The metrics developed that are shown in this report are an attempt to quantify each of these principles.

The data are organized according to the BMC QUEST pneumonic (Quality, Efficiency, Satisfaction, Total Revenue).

Principles of Collaboration for E6W

1

Evidence-Based CareCare provided will be:-- Based on the current best practices-- Be standardized among all providers-- Be informed by a rigorous CQI process

Timely, High Quality Communication• Frequent communication is needed for safe

provision of care • Board rounds each AM+PM • Nursing input at board + bedside rounds• Communication with primary care team • A dialogue among providers for each

change in plan or patient transfer • Use of a standardized tool for handoffs • Use language that patients understand

Acceptable Case Load• Safe patient care is possible only if there are

well rested providers responsible for a reasonable number of patients

• Acceptable daily work load

Patient satisfaction• Is a responsibility of all team members• Is a key metric for quality • Family members are our customers

Family Medicine, Boston HealthNet Inpatient ServicePrinciples of Collaboration for 6 West Inpatient Unit

Partners: Patients, Physicians, Nurses, Community Health Center Administration and Staff, Boston Community Medical Group, Physician Assistants, Consulting Services, Students, Nursing Education, Pharmacists, Physical and Occupational Therapists Environmental Services, Nutrition and Dietary and Community-based

providers including rehab units and SNFs

Safe Transitions• Good communication at admission +

discharge• All pts know how to care for themselves at dc• Implement ReEngineered Discharge

Maximize Continuity• Communicating with PCP is a priority• Information will flow smoothly from the

ambulatory providers to the unit and from the unit to site of post hospital care.

Excellence in Education• All team members have responsibility for the

education of residents, students and other trainees.

• Nursing education is valued • All providers are responsible for orienting and

teaching new members of the team about the appropriate management and flow on the floor.

Good Documentation• There will be clear and consistent

documentation of all care delivered• Will reconcile medications and care at all

times• Health proxy and end of life care to be

documented at all times

Team Focused• Responsibility for care rests with a team of

professionals rather than a single provider.• Patient Care is a shared responsibility• Team includes outpatient partners• Implement Teams training

Clarity of Responsibility• The identity of the provider and the team

responsible for each case will be clear to all staff at all times.

Citizenship• Interactions among team members are

respectful and collaborative at all times • Frequent physical presence on the floor

will promote communication and collaboration

High Efficiency• Promote early discharge• Team will work to minimize redundancy • The provider with the highest level of

training should be caring for those patients who need the highest level of care.

Our Mission: To provide safe, high quality, evidence based, efficient, patient centered care at all times in an environment of collaboration and team work.

QuESTThe Family Medicine HealthNet Inpatient service uses QuEST, the BMC framework to measure outcomes

QuEST stands for:QualityEfficiencySatisfactionTotal Revenue

7

QUALITY: Mortality Analysis For Family Medicine

Attending Note Compliance for Non- Surgical Departments

All-Cause 30-Day Readmission Rate

EFFICIENCY: Daily Workload by Care Team (Census Counted at 8am)

Weekly Average Discharge Time

Average Length of Stay Of Inpatient Discharges by Care Team

Average Length of Stay Of All BMC Admissions

Average Length of Stay Of Observation Discharges by Care Team

Monthly Length of Stay (Observed/Expected Ratio)

Average Length of Stay (Observed and Expected)

Percentage of Patients Admitted to E6W

Satisfaction: HCAHPS Quarterly Patient Experience Trends: E6W

Communication Standards

Total Revenue: Total Number of Patients Admitted and Discharged by Care Team

Monthly Total Number of Patients Admitted by Care Team

Average Total Admissions and Discharges by Day of Week

Percent of Admissions and Discharges in Observation Status by Care Team

Percent of All Admissions by Patient Class

Patients Lost◦ HealtHNet Patients’ Admissions For All Services ◦ Monthly Percentage of HealthNet Patients’ Admissions to FM-HN◦ HealthNet Patients’ Admissions by Health Center◦ CCA Patients Lost◦ HealthNet Patients Lost to Cardiology

Mortality Analysis for Family Medicine

Note: Discharges with non-viable neonates, or point of origin is hospice are excluded. Discharges from MICU to floor transfers are included.

Source: UHC, Patient Outcomes Report

FM-HN continues to have Om < Em

Q1 2013 (N= 625)

Q2 2013 (N=583) Q3 2013 (N= 575) Q4 2013 (N=609) Q1 2014 (N=576) Q2 2014 (N=581) Q3 2014 (N=596)0.00

0.50

1.00

1.50

2.00

2.50

Medical MS-DRG Mortality Analysis for Family Medicine

Observed Expected

Mor

talit

y Ra

te (%

)

Q1 2013 (N= 625)

Q2 2013 (N=583)

Q3 2013 (N= 575)

Q4 2013 (N=609)

Q1 2014 (N=576)

Q2 2014 (N=581)

Q3 2014 (N=596)

% ICU Cases 9.28 10.46 12.17 11.82 11.11 10.15 9.06

Inpatient Mortality Index

Source: UHC, Patient Outcomes Report

BMC wants to achieve a score of .77 or lower. FM

has always been significantly lower than

that.

Q1 2013 (N= 625)

Q2 2013 (N=583) Q3 2013 (N= 575) Q4 2013 (N=609) Q1 2014 (N=576) Q2 2014 (N=581) Q3 2014 (N=596)0.00

0.10

0.20

0.30

0.40

0.50

0.60

0.70

0.80

0.90

1.00

Mortality Index for Family Medicine

Mortality O/E Goal

Case Mix Index

Note: Discharges with non-viable neonates, or point of origin is hospice are excluded.

Q1 2013 Q2 2013 Q3 2013 Q4 2013 Q1 2014 Q2 2014 Q3 20140.95

1.05

1.15

1.25

1.35

1.45

Case Mix Index

FM CMI FM Medicare CMI GIM CMI GIM Medicare CMI

Quarter

CMI

Attending Note Compliance for Non- Surgical Departments

Source: BMC Administration

FM-HN attending continue to sign charts according to standard

All-Cause 30-Day Readmission Rate

Endocrinology (

n= 68)

Nephrology (

n=520)

Hematology/Onco

logy (n=588)

Gastroentoro

logy (n=59)

MICU (n

=2008)

Infectious D

isease

s (n=958)

General In

ternal M

edicine (n

=2782)

Geriatri

cs (n=649)

Rheumatology (n=42)

Cardiology (

n=1885)

Pulmonary,

Allerg

y, & CCM

(n=21)

FM-H

N (n=1884)

0%5%

10%15%20%25%30%35%

18.00%13.70%

30 Day All-Cause Readmission Rate for All Medical Services (May 2013-April 2014)

Medical Service

Read

miss

ion

Rate

Note: The attribution is based on the mortality analysis logic

Source: BMC Administration- distributed at July 2014 Readmission meeting

FM-HN has the lowest readmission rate among all the medical services.

Readmissions

Q1 2013 Q2 2013 Q3 2013 Q4 2013 Q1 2014 Q2 2014 Q3 20149.5

11.5

13.5

15.5

17.5

19.5

21.5

All-Cause 30 Day Readmission

FM BMC GIM

Quarter

Read

miss

ion

Rate

(%)

Daily Workload by Care Team (Census Counted At 8AM)

• CCA volume peaked for a day,

but then went back to average

• PA and FM team have the same

average number of patients

Source (both graphs): SDK Combined Census Report and confirmed with EPIC census on weekdays

11/111/3

11/511/7

11/911/1

111/1

311/1

511/1

711/1

911/2

111/2

311/2

511/2

711/2

90

2

4

6

8

10

12

14

16

Daily Workload by Care Team in November

FM 1 8 AM Census FM 2 (PA) 8 AM Census CCA 8 AM Census

Date

Num

ber o

f Pati

ents

June July August September October November0

5

10

15

20

25

30

9 10 9 9 11 10

1011

10 9

1110

5

76

4

55

Average Daily Workload by are Team (at 8 am)

FM 1 FM 2 (PA) CCA

Month

Num

ber o

f Pati

ents


Source: Weekly hospital reports (From Jonathan Bunker)

FM-HN continues to lead hospital in average discharge time.

6/1 6/86/1

56/2

26/2

97/6

7/13

7/20

7/27

8/38/1

08/1

78/2

48/3

19/7

9/14

9/21

9/28

10/510/1

210/1

910/2

611/2

11/911/1

611/2

313:26

13:55

14:24

14:52

15:21

15:50

16:19

16:48


FM-HN Entire Hospital Avg of H6E & H6W

Date

Disc

harg

e Ti

me

Total Number of Patients Admitted and Discharged in November by Care Team

Source: EPIC, Department of Medicine Admissions and DOM Discharges by Month report

For FM team #admissions < # discharges

For PA team#admissions < # discharges

For CCA team#admissions= #discharges

FM 1 FM 2 (PA) CCA0

20

40

60

80

100

120

88

110

45

85

112

45

Total Number of Patients Admitted and Discharged in November by Care Team

Admissions Discharges

Care Team

Num

ber

of P

atien

ts

Monthly Total Number of Patients Discharged by Care Team

Source: EPIC, DOM Discharges by Month report

• FM-HN continues to maintain a constant volume about 8 admissions per day.

July August September October November0

50

100

150

200

250

300

93 97 95 10985

106 89 94

128

112

4750 36

45

45

Monthly Total Number of Patients Discharged by Care Team in November

FM 1 FM 2 (PA) CCA

Month

Num

ber

of P

atien

ts

AY12 AY13 AY140

500

1,000

1,500

2,000

2,500

3,000

3,500

206 198 0

222 260

0

300 387

0

800967

0

11611162

0

2028

1119

ObservationsDischarges NoxEve269420941494

Annual Volume

Average Total Admissions and Discharges in November by Day of Week

• Monday and Tuesday had the highest number of admissions

• Monday and Tuesday had the highest number of discharges

• Monday and Tuesday were the busiest days in November

Source: EPIC, Department of Medicine Admissions and DOM Discharges by Month Report

Friday Saturday Sunday Monday Tuesday Wednesday Thursday0

5

10

15

20

25

30

35

40

45

50

40

3537 36

42

2528

32

38

23

4245

3230

Average Total Admissions and Discharges in November by Day of Week


Day of Week

Num

ber o

f Pati

ents

Percent of November Admissions and Discharges in Observation Status by Care Team

Source: EPIC, Department of Medicine Admissions and DOM Discharges by Month Report

The FM 1 team admitted < patients in obs status than it d/c

The FM 9 (PA) and the CCA teams admitted > patients in obs status than it d/c

FM 1 FM 2 (PA) CCA0%

5%

10%

15%

20%

25%

30%

35%

40%

35.2% 35.5%

26.7%

37.6%

34.8%

22.2%

Percent of Admissions and Discharges In Observation Status in November


Care Team

Perc

enta

ge

July August September October November10%

15%

20%

25%

30%

35%

40%

45%

50%

Monthly Percentage of Discharges in Observation Status by Care Team

FM 1 FM 2 (PA) CCA

Month

Perc

enta

ge

Admissions in November by Patient Class

Source: EPIC, Department of Medicine Admissions

64.9% of all admissions were in inpatient status.

Inpatient Observation0%

10%

20%

30%

40%

50%

60%

70% 66.3%

33.7%

Admissions in November by Patient Class

Patient Class

Perc

enta

ge

Average Length of Stay of Inpatient Discharges in by Care Team (In Days)

Source: EPIC (From DOM Discharges by Month report)

Based on Mean- CCA has always had a longer ALOS and the ALOS for CCA, and FM 1 increased since October

Based on Median- CCA usually has a higher ALOS but was similar to FM1 and FM 1 in August and September ALOS for FM 1 increased since October

June July August September October November2.5

3.1

3.7

4.3

4.9

Monthly Length of Stay of Inpatient Discharges by Care Team Based on the Mean (In Days)

FM 1 FM 2 (PA) CCA

Month

Aver

age

Leng

th o

f Sta

y (In

Day

s)

FM (n=53) FM 2 (PA) (n=73) CCA (n=35)0

1

2

3

4

5

6

4.05

3.28

4.95

2.622.17

3.85

Average Length of Stay of Inpatient Discharges in November by Care Team (In Days)

Mean Median

Care Team

Aver

age

Leng

th o

f Sta

y (In

Day

s)

June July August September October November1.5

22.5

33.5

44.5

Monthly Length of Stay of Inpatient Discharges by Care Team Based on Median (In Days)

FM 1 FM 2 (PA) CCA

Month

Aver

age

Leng

th o

f Sta

y (In

Day

s)

Average Length of Stay of Inpatient admissions in October by Day of The Week (In Days)

FROM DATE OF ADMISSION FROM DATE OF DISCHARGE People admitted on Wednesday, Thursday and Saturday have a

longer LOS and people admitted on Sunday and Monday have a

shorter LOS

People discharged on Friday, Sunday, and

Monday longer LOS & people discharged on Saturday and Tuesday

have a shorter LOS

Source: EPIC (From Department of Medicine Admissions and DOM Discharges by Month report)


0.51

1.52

2.53

3.54

4.55

3.6

2.92.6

5

3.4 3.3 3.32.9 2.8

2.4

3.42.9

2.62.1

Average Length of Stay of Inpatient Admissions in November for FM-HN Service (In Days)

Mean Median

Day of Week

ALO

S (In

Day

s)


1

2

3

4

5

6

4

2.8

1.8

4.7

5.5

4.2

32.4

2.1 2

3.8

5

2.6 2.8

Average Length of Stay of Inpatient Discharges in November for FM-HN Service (In Days)

Mean Median

Day of WeekAL

OS

(In D

ays)

Average Length Of Stay by Day of Discharge in September

Source: UHC, Patient Outcomes by Discharge Day

FM-HN ALOS is always lower than the ALOS for BMC and

Sunday Monday Tuesday Wednesday Thursday Friday Saturday2.5

3.5

4.5

5.5

6.5

7.5

8.5

ALOS by Day of Discharge in September

BMC FM-HN GIM

Day of Week

ALO

S (I

n D

ays)

Average Length of Stay of Observation Discharges in October by Care Team (In Hours)

Based on the Mean- the ALOS for all three teams decreased since October

Based on the Median- the ALOS for CCA and FM 2 decreased but slightly increased for FM 1

Source: EPIC , DOM Discharges by Month report

Average Length of Stay of Discharges in October by Care Team (In Hours)


Monthly Average Length of Stay of Observation Dis-charges by Care Team Based on the Mean (In Hours)

FM 1 FM 2 (PA) CCA

Month

Aver

age

Leng

th o

f Sta

y (In

Hou

rs)

FM (n=32) FM 2 (PA) (n=39) CCA (n=10)0

5

10

15

20

25

30

35

29.527.04

28.47

24.522.6 21.9

Average Length of Stay of Observation Discharges in November by Care Team (In Hours)

Mean Median

Care Team

Aver

age

Leng

th o

f Sta

y (In

Hou

rs)


Average Length of Stay of Observation Discharges by Care Team Based on the Median (In Hours)

FM 1 FM 2 (PA) CCAMonth

Aver

age

Leng

th o

f Sta

y (In

Hou

rs)

Average Length of Stay of Observation Admissions in October by Day of The Week (In Hours)

ALOS FROM ADMISSION DATE ALOS FROM DISCHARGE DATE Admissions on Friday and Sunday have a

longer LOS and admissions on Thursday

and Monday have a shorter LOS

Discharges on Monday and Tuesday have a longer LOS and discharges on Sunday,

Saturday and Wednesday have a

shorter LOS

Source: EPIC (From Department of Medicine Admissions and DOM Discharges by Month report)


5

10

15

20

25

30

35

40

31.2

23.927.1

31.9

23.726.9

34.7

23.7 22.7 22.225.1

18.6

24

28.2

Average Length of Stay of Observation Discharges in November for FM-HN Service (In Hours)

Mean Median

Day of WeekAL

OS

(In H

ours

)


10

20

30

40

50

60

26.8

60.7

34.4

25.9 23.5

37.9

2926.3

22.2

29.6

19.3 21.4

36.4

21

Average Length of Stay of Observation Admissions in No-vember for FM-HN Service (In Hours)

Mean Median

Day of Week

ALO

S (I

n Ho

urs)

Comparing ALOS for Inpatient and Observation Admissions in October: With and Without the CCA team

INPATIENT ADMISSIONS OBSERVATION ADMISSIONS

Inpt ALOS is .3 hours less when CCA is excluded

Obs ALOS is .04 hours less when CCA is excluded

FM 1, FM 2 (PA), CCA FM 1 & FM 2 (PA)28.0028.0228.0428.0628.0828.1028.1228.1428.1628.1828.20 28.19

28.15

Comparison of Average Length of Stay of Ob-servation Admissions in November

Care Team

Aver

age

Leng

th o

f Sta

y (In

Hou

rs)

FM 1, FM 2 (PA), CCA FM 1 & FM 2 (PA)3

3.1

3.2

3.3

3.4

3.5

3.6

3.7

3.8

3.9

43.9

3.6

Comparison of Average Length of Stay of Inpa-tient Admissions in November

Care Teams

Aver

age

Leng

th o

f Sta

y (In

Day

s)

Note: ALOS is based on mean


Source: EPIC, Department of Medicine Admissions

In November FM-HN admitted about 88% of patients to E6W. The percentage of Admissions to E6W has increased since October

87.7%

Percentage of Patients Admitted by FM-HN in November by Floor

E6W

E7E

E7N

E7W

E8E

E8W

July August September October November0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%

84.0%88.7% 89.6%

83.0%87.7%


% admitted to E6W Goal

Percentage of Patients Discharged from E6W

88.0%

Percentage of Patients Discharged From FM-HN by Floor

E6W

E7E

E7N

E7W

E8E

E8W

November December0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Percentage of Patients Discharged From E6W

Month

Perc

enta

ge

HCAHPS: Quarterly Patient Experience Trends: BMC & E6W

2012 Q4 2013 Q1 2013 Q2 (n=159, 13)

2013 Q3 (n=158, 7) 2013 Q4 (n=291, 20)

2014 Q1 (n=431, 39)

2014 Q2 (n=422,44)

2014 Q3 (n=411, 36)

0

10

20

30

40

50

60

70

80

90

100

Recommended Hospital

BMC 6W Target

Rate

(%)

Note: The percentage presented in these graphs are the top box score percentages Source: BMC Administration (From Inpatient Dashboard)

E6W had a higher percentage for

recommending the hospital


2012 Q4

2013 Q1

2013 Q2 (n=1

59, 13)

2013 Q3 (n=1

58, 7)

2013 Q4 (n=2

91, 20)

2014 Q1 (n=4

31, 39)

2014 Q2 (n=4

22,44)

2014 Q3 (n=4

11, 36)

0

10

20

30

40

50

60

70

80

90

100

Communication with Nurses

BMC 6W Target

Rate

(%)

2012 Q4 2013 Q1 2013 Q2 (n=159,

13)

2013 Q3 (n=158, 7)

2013 Q4 (n=291,

20)

2014 Q1 (n=431,

39)

2014 Q2 (n=422,44)

2014 Q3 (n=411,

36)

0

10

20

30

40

50

60

70

80

90

100

Communication with Doctors

BMC 6W Target

Rate

(%)


E6W had a lower score than BMC

for communication with nurses and communication

with doctors


2012 Q4 2013 Q1 2013 Q2 (n=159,

13)

2013 Q3 (n=158, 7)

2013 Q4 (n=291,

20)

2014 Q1 (n=431,

39)

2014 Q2 (n=422,44

)

2014 Q3 (n=411,

36)

0

10

20

30

40

50

60

70

80

90

100

Response of Hospital Staff

BMC 6W Target

Rate

(%)

2012 Q4 2013 Q1 2013 Q2 (n=159,

13)

2013 Q3 (n=158, 7)

2013 Q4 (n=291,

20)

2014 Q1 (n=431,

39)

2014 Q2 (n=422,44

)

2014 Q3 (n=411,

36)

0

10

20

30

40

50

60

70

80

90

100

Pain Management

BMC 6W TargetRa

te (%

)


E6W had a lower score than BMC at both responsible of hospital staff

and pain management


2012 Q4 2013 Q1 2013 Q2 (n=159,

13)

2013 Q3 (n=158, 7)

2013 Q4 (n=291,

20)

2014 Q1 (n=431,

39)

2014 Q2 (n=422,44)

2014 Q3 (n=411,

36)

0

10

20

30

40

50

60

70

80

90

100

Communication about Medicines

BMC 6W Target

Rate

(%)

2012 Q4 2013 Q1 2013 Q2 (n=159,

13)

2013 Q3 (n=158, 7)

2013 Q4 (n=291,

20)

2014 Q1 (n=431,

39)

2014 Q2 (n=422,44)

2014 Q3 (n=411,

36)

0

10

20

30

40

50

60

70

80

90

100

Discharge Information

BMC 6W Target

Rate

(%)


E6W had a lower score than BMC

for both communication about medicines

and discharge information


2012 Q4 2013 Q1 2013 Q2 (n=159,

13)

2013 Q3 (n=158, 7)

2013 Q4 (n=291,

20)

2014 Q1 (n=431,

39)

2014 Q2 (n=422,44

)

2014 Q3 (n=411,

36)

0

10

20

30

40

50

60

70

80

90

100

Cleanliness of Hospital Environment

BMC 6W Target

Rate

(%)

2012 Q4 2013 Q1 2013 Q2 (n=159,

13)

2013 Q3 (n=158, 7)

2013 Q4 (n=291,

20)

2014 Q1 (n=431,

39)

2014 Q2 (n=422,44)

2014 Q3 (n=411,

36)

0

10

20

30

40

50

60

70

80

90

100

Quietness of Hospital Environment

BMC 6W Target

Rate

(%)


E6W had a slightly higher score than

BMC for cleanliness but

had a lower score for quietness

Communication Standards

About 91% of PCPs are

contacted upon admission and

95% upon discharge

Source: Communications Excel Tracking Sheet

November '13

December '13

January '14 February '14 March '14 April '14 May '14 June '14 July '14 August '14 September '14

October '14 November '14

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100% 95% 96%

Percent of Patient's PCPs Contacted Upon Admisison and Discharge

% of PCPs contacted at Admission Percentage of PCPs Contacted at Discharge

Month

Perc

enta

ge

Patients Lost◦ HealtHNet Patients’ Admissions For All Services

◦ Monthly Percentage of HealthNet Patients’ Admissions to FM-HN

◦ HealthNet Patients’ Admissions by Health Center

◦ HealthNet Patients Lost to Cardiology

HealthNet Patients’ Admissions for ALL Services In October

About 57% of HealthNet patients were admitted into the FM-HN Service in November Goal: ??

Source: Individual SDK Inpatient and Observation admissions by Health Center report

Note: This graph includes patients with a PCP in Family Medicine Yawkey

7.80%2.20%

9.60%

57.10%

23.60%

HealthNet Patient's Admissions in November

E Card Gen

E Card CHF

Medical Services

FM-HN

ED Obs Unit

August September October November0%

10%

20%

30%

40%

50%

60%

70%

57% 56%62%

57%

HealthNet Patient's Admissions to FM-HN Service

Month

Perc

enta

ge

HealthNet Patients’ Admissions In October by Health Center


FM-HN loses the least patients from Geiger/Neponset, Mattapan, South Boston,and East

Boston (n>5)100%

Greater Roslinale (1)

6.8%

6.8%

9.1%

77.3%

South Boston (44)

7.7%0.6%

19.2%

67.8%

Yawkey ACC (52)

11.1%

8.3%

13.9%

66.7%

Dorchester (36)

33.3%

66.7%

Geiger/Neponset (6)

7.7% 5.1%

20.5%

66.7%

Upham's Corner (39)

FM-HN

ER

Cardiology

Medical Teams

HealthNet Patients’ Admissions In October by Health Center (Cont.)


FM-HN loses the most patients from

Whittier, Roslindale, and

Harvard

11.4%

10.2%

15.9%62.5%

East Boston (88)

7.7%

12.8%

25.6%

53.8%

Codman Square (39)

11.5%

7.7%

30.8%

50.0%

Mattapan (26)

17.4%4.3%

30.4%

47.8%

Whittier St. (23)

23.1%

15.4%

23.1%

38.5%

Harvard St. (13)

33.3%

33.3%

33.3%

Manet (3)

100.0%

South End (1)

FM-HN

ER

Cardiology

Medical Teams

APPENDIX

Variability in staffing patterns, operations, and processes results in significant differences in discharge timing

ServiceAverage

discharge timeAverage daily

discharges

Cath Lab 1:22:41 PM 1.2Family Medicine – PA 1:40:15 PM 4.9EP 1:41:27 PM 0.5Ambulatory Surgery 1:42:00 PM 2.0Surgical Subspecialty 2:20:02 PM 10.1Neurology 2:34:41 PM 0.4Pediatric Surgery 2:40:00 PM 0.6Maternity 2:42:19 PM 8.0Family Medicine – Resident 2:46:47 PM 3.7Newborn 2:47:40 PM 5.7General Surgery 2:48:13 PM 8.7Medicine – Hospitalist 2:49:41 PM 6.4Gynecology 3:05:39 PM 1.7ED OBS 3:07:57 PM 4.9CHF 3:15:15 PM 1.9ID 3:17:36 PM 2.9Medicine – Resident 3:22:59 PM 11.0Oncology 3:27:45 PM 2.1General Neurology 3:31:36 PM 2.4General Cardiology 3:50:23 PM 3.1Renal 4:01:25 PM 2.8General Pediatrics 4:11:13 PM 5.2Geriatrics 4:12:30 PM 3.3

Average discharge time: 2:58 PM

Advancing all these teams to the current mean would save a total of 25.6 bedded patient-hours each day.

30 Day All-Cause Readmission by Service

Service Den Num30 Day All-Cause

Readmission Rate (%)ENP HEM/ONC 712 224 31.46%ENP RENAL 711 210 29.54%E PULMONARY IP 52 12 23.08%E VASCULAR SURGERY 256 59 23.05%E CARDIOLOGY CHF 576 127 22.05%MP TEAM 3 774 161 20.80%MP TEAM 5 449 89 19.82%ENP 2 230 45 19.57%MP GERIATRIC IP 824 149 18.08%MP TEAM 6 372 66 17.74%MP TEAM 4 796 138 17.34%E TRANSPLANT 76 13 17.11%MP TEAM 2 738 126 17.07%MP TEAM 1 742 125 16.85%H MEDICU 132 22 16.67%ENP 1 264 43 16.29%E INTERNAL MED IP 388 61 15.72%H REHAB CENTER BMC 80 12 15.00%ENP FM 735 103 14.01%E CARDIOTHORACIC SURGERY 437 60 13.73%ENP PA 1042 143 13.72%E CARDIOLOGY GENERAL 682 93 13.64%E CCU 327 39 11.93%Note: Services with less than 30 index cases are excluded.

Lack of clinical practice standardization across services results in variable LOS for patients with similar DRGs … LOS for Observation admissions with primary diagnosis of non-specific chest pain

Average hours

Source: SDK dataset, 8/1/2013-1/31/2014.

family medicine healthnet inpatient service quality report and unit dashboard: bmc e6w quest:...

Documents

family medicine practices

inpatient team

inpatient discharges

bmc quest pneumonic

care team census

bmc e6wquest

high quality services

bmc framework