fha hiin readmissions peer sharing webinar: improving …jul 24, 2018 · transition of care –...
TRANSCRIPT
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 [email protected] to request a topic for discussion
