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Improving patient satisfaction and reducing readmission rates with interprofessional rounds Cindy Atkinson RN, MSN,CNL, DNP student; Linda Hulton, PhD., RN; Margaret Bagnardi, EdD, MSN, RN, CCRN, CNL James Madison University School of Nursing • Data was gathered pre-implementation (prior to Jan 2, 2018), at 3 months, and 6 months post implementation data in process. • Retrospective chart review was done. • Post data from the patient satisfaction survey provided by National Research Corporation, will be compared and analyzed with pre-data. • The 30-day readmission rate data for Medicare patients obtained from Health Quality Innovators. \. Background Intervention Method Conclusion Preliminary Results • A 255-bed nonprofit, community hospital in a mid-Atlantic State. • The Center for Medicare and Medicaid Services has put a strong emphasis on decreasing readmission rates and subsequent withholding of reimbursement for hospitals (Zakzesky, et al., 2015). • The community hospital had concerns regarding lack of reimbursement based on readmissions, decreased safety, patient satisfaction, and increase in hospital cost (Burns, K., 2011). • Lack of interprofessional communication delays a patient’s discharge, ties up available beds, reduces availability to accept admissions and transfers, promotes readmissions, and decreased patient satisfaction (Burns, K., 2011). • Implement interprofessional collaboration rounds on a 55-bed telemetry unit and evaluate the outcomes on patient satisfaction and readmission rate. • Increase patient satisfaction scores by 2.5% and reduce readmission rates by 10% with implementations. Pre-data December 2017- Readmission rates on PCU were at 17% and at 3 months 17.67% • December 2017 patient satisfaction with discharge from PCU was 61.9% and at 3 months 70% • Awaiting for 6 month post data. Measures IHI quality improvement model – Plan-Do-Study-Act Three questions will be addressed in the intervention. • What are we trying to accomplish? • How will we know that a change is an improvement? • What change can we make that will result in improvement (Institute for Healthcare Improvement, 2018 ? PDSA is a rapid-cycle quality improvement method that identifies, implements and measure changes to improve a process or system (Institute for Healthcare Improvement, 2018). Project Timeline • Interprofessional Rounds are held Monday-Friday at 11am at the Nurses’ Station on PCU. • Rounds are Case Management led • Rounds are attended by the Hospitalists, Case Managers, Pharmacy, and the Charge Nurse of PCU • Every patient admitted under a hospitalist care are discussed in rounds, discharge plans and needs are discussed. • Goal length of Interprofessional Rounds is 20 minutes 0 10 20 30 40 50 60 70 80 90 Jun-17 Aug-17 Oct-17 Dec-17 Feb-18 Apr-18 Jun-18 Patient Satisfaction Scores Readmission rates Purpose/ Aim Problem PDSA 1: Initial planning stages. Go Live with 1 Doctor May-Oct 2017 PDSA 2: Redesign of documentation template Oct-Dec 2017 PDSA 3: Change location of IR to Nurse's station Dec 2017-Jan 2018 PDSA 4: Stopped using documentation template, case manager documents and flows to nursing status board Jan-Feb 2018 PDSA 5: Set goal time limit to 30 min., stopped giving Doctors "heads up" page Feb-April/May 2018 PDSA 6: removal of set times for Doctors, encourage nurse participation, doctors to give quick 2 sentence summary April/May 2018- present Implications Methods • Data collection still in process. • Interprofessional communication and collaboration brings together several disciplines to round on each patient. • Promotes a clear plan of discharge from the time of admission. • Further research and pilot studies are needed to analyze promotion of positive patient outcomes for future models of care.

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Page 1: Improving patient satisfaction and reducing readmission ...dnpconferenceaudio.s3.amazonaws.com/2018/AtkinsonC... · PDSA is a rapid-cycle quality improvement method that identifies,

Improvingpatientsatisfactionandreducingreadmissionrateswith

interprofessionalroundsCindyAtkinsonRN,MSN,CNL,DNPstudent;LindaHulton,PhD.,RN;MargaretBagnardi,EdD,MSN,RN,CCRN,

CNLJamesMadisonUniversitySchoolofNursing

•  Datawasgatheredpre-implementation(priortoJan2,2018),at3months,and6monthspostimplementationdatainprocess.

•  Retrospectivechartreviewwasdone.•  PostdatafromthepatientsatisfactionsurveyprovidedbyNationalResearchCorporation,willbecomparedandanalyzedwithpre-data.

•  The30-dayreadmissionratedataforMedicarepatientsobtainedfromHealthQualityInnovators.

\.

Background Intervention

MethodConclusion

PreliminaryResults

•  A255-bednonprofit,communityhospitalinamid-AtlanticState.

•  TheCenterforMedicareandMedicaidServiceshasputastrongemphasisondecreasingreadmissionratesandsubsequentwithholdingofreimbursementforhospitals(Zakzesky,etal.,2015).

•  Thecommunityhospitalhadconcernsregardinglackofreimbursementbasedonreadmissions,decreasedsafety,patientsatisfaction,andincreaseinhospitalcost(Burns,K.,2011).

•  Lackofinterprofessionalcommunicationdelaysapatient’s

discharge,tiesupavailablebeds,reducesavailabilitytoacceptadmissionsandtransfers,promotesreadmissions,anddecreasedpatientsatisfaction(Burns,K.,2011).

•  Implementinterprofessionalcollaborationroundsona55-bed

telemetryunitandevaluatetheoutcomesonpatientsatisfactionandreadmissionrate.

•  Increasepatientsatisfactionscoresby2.5%andreducereadmissionratesby10%withimplementations.

Pre-dataDecember2017-ReadmissionratesonPCUwereat17%andat3months17.67%•  December2017patientsatisfactionwithdischargefromPCUwas61.9%andat3months70%

•  Awaitingfor6monthpostdata.

MeasuresFigure 1. Interprofessional Rounds Timeline

IHIqualityimprovementmodel–Plan-Do-Study-ActThreequestionswillbeaddressedintheintervention.•  Whatarewetryingtoaccomplish?•  Howwillweknowthatachangeisanimprovement?•  Whatchangecanwemakethatwillresultinimprovement

(InstituteforHealthcareImprovement,2018?PDSAisarapid-cyclequalityimprovementmethodthatidentifies,implementsandmeasurechangestoimproveaprocessorsystem(InstituteforHealthcareImprovement,2018).

ProjectTimeline

•  InterprofessionalRoundsareheldMonday-Fridayat11amattheNurses’StationonPCU.

•  RoundsareCaseManagementled•  RoundsareattendedbytheHospitalists,CaseManagers,Pharmacy,andtheChargeNurseofPCU

•  Everypatientadmittedunderahospitalistcarearediscussedinrounds,dischargeplansandneedsarediscussed.

•  GoallengthofInterprofessionalRoundsis20minutes

0102030405060708090

Jun-17

Aug-17

Oct-17

Dec-17

Feb-18

Apr-18

Jun-18

PatientSatisfactionScores

Readmissionrates

Purpose/Aim

Problem

PDSA1:Initialplanningstages.GoLivewith1DoctorMay-Oct2017

PDSA2:Redesignofdocumentationtemplate

Oct-Dec2017

PDSA3:ChangelocationofIRtoNurse'sstationDec

2017-Jan2018

PDSA4:Stoppedusingdocumentationtemplate,casemanagerdocumentsandflowstonursingstatus

boardJan-Feb2018

PDSA5:Setgoaltimelimitto30min.,stoppedgivingDoctors"headsup"pageFeb-April/May2018

PDSA6:removalofsettimesforDoctors,encouragenurseparticipation,doctorstogivequick2sentence

summaryApril/May2018-present

ImplicationsMethods

•  Datacollectionstillinprocess.•  Interprofessionalcommunicationand

collaborationbringstogetherseveraldisciplinestoroundoneachpatient.

•  Promotesaclearplanofdischargefromthetimeofadmission.

•  Furtherresearchandpilotstudiesareneededtoanalyzepromotionofpositivepatientoutcomesforfuturemodelsofcare.

5

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