kelli clifton-graduate administrative intern office of the president/department of surgical services...
TRANSCRIPT
Kelli Clifton-Graduate Administrative Intern
Office of the President/Department of Surgical Services
2010 MHA Candidate-The Ohio State University
Summer 2009
Ambulatory Surgery Center (ASC) Patient Satisfaction:
Striving for 5’s Through Patient Communication
Agenda
• Problem Identification and Purpose of Project
• Selection of Pilot Locations
• Electronic Discharge Instruction
• Olson Discharge Process Re-design
• Organizational Impact of Project
Problem
For the baseline period of Q3 FY 09, the overall ASC patient satisfaction goal was 75.7% (VG). In comparison, the actual overall ASC patient satisfaction score was 71.4%(VG) ( 4.3%).
Purpose of ProjectDevelop a perioperative experience that includes timely,
consistent and accurate information for Ambulatory Surgery
Center (ASC) patients and families
– Directly supports Best Patient Experience (BPE) strategic plan
– Specific focus on patient satisfaction, measured by Press Ganey Survey
%VG for Questions Within ScopeFY 09 (Q1-Q3) -Goal 75.7% (VG)
67.4%
68.3%
71.5%
Goal Benefit:Increase ENT and Orthopaedics scope questions by 50% VG.
Overview
Electronic Discharge Instructions
Deliverables:
Discharge Phone Call Tracking
Discharge Process Re-design within Olson
Scope: 12 week pilot focused within Olson ASC Orthopaedics and ENTspecialties.
Pilot Locations
Specialties with “room” to improve PG scores
Identifiable physician champion
Specialties with n>30 survey response rate
Selection of Physician Champion
Orthopaedic Procedures within Scope
Deliverable 1:Electronic Discharge Instructions (DI)
RisksRisks
• Illegibility
• Static
• Lacks patient education
• Increase in unplanned re-admissions
Options for the Improvement of Discharge Instructions
Electronic Discharge Instructions Implementation: Difficulty versus Impact
Written Instructions
Electronic Version-
PowerChart
Contract with Vendor
0
2
4
6
8
10
0 2 4 6 8 10Solution Impact
Imp
lem
enta
tio
n D
iffi
cult
y
• Surgeon can complete instructions either prior to or after surgery
• Nurse prints for review with patient
Before After
Benefits Benefits
• Comprehensive patient education
• Promotes medication compliance
• Customized per surgeon/patient
• Reduces errors due to illegibility
• Immediate electronic documentation
Pilot among MD’s within specific specialt
y
Implement generic electronic discharge instructions
pavilion-wide
Customize discharge instructions by specialty
2
3
Recommendations: Strategically Roll-out Electronic DI
Completed during 12 week scope
1
Designate specific “go-live” plan for all pavilions
Incorporate IS and clinical staff
Recommendations: Strategically Roll-out Electronic DI
It is recommended that the Department of Surgical Services completely pilot the EDI process within the Orthopedics specialty before moving on to ENT and other departments. Specifically, it is recommended that additional Orthopaedics physicians are added to the template.
At the end of the project, the electronic discharge instructions (EDI) were piloted only within the Orthopaedics specialty. Originally, the plan was to pilot among both Orthopaedics and ENT. During the initial roll out phase, logistical issues such as physician training within PowerChart, physician requests for more customization, and concerns regarding the wording of phrases delayed the ability to roll out the process to other specialties such as ENT. In order to complete the goal, the following steps should be taken:
Recommendations: Strategically Roll-out Electronic DI
Collection of Information
1) Identify surgeons based on case volume and procedure type. For example: include surgeons who perform knee and shoulder arthroscopies since these procedures were not included in the original pilot.
2) If available, collect the current (paper) discharge instructions that the surgeons give to their patients. If pre-printed copies are not available, ask the surgeon to complete the Ambulatory Discharge Instructions Form.
3) Look for similarities among the discharge instructions. If two or more surgeons communicate the same message, this should be a standard prompt within the EDI template. If only one surgeon communicates a unique message, this can be typed into the “what” box or added specifically for the surgeon.
4) Once the discharge instructions are identified, decide under which “domain” they should fall. For example: activity, post-operative medication, diet…. Collaborate with Information Services Documentation Specialist to have the instructions
“built” into the PowerChart note.
Recommendations: Strategically Roll-out Electronic DI
Pilot Phase1) Once the instructions have been added to PowerChart, select two or three days, where
a ‘trainer’ can assist the surgeon in completing the EDI. It is recommended that the sheet entitled Process Map-Generate Discharge Instructions-MD be used for training.
2) During the phase, identify questions or concerns raised by physicians and nursing staff.
3) Using the Request to Amend Ambulatory Discharge Instructions Form, submit any changes to the IS department.
4) Once the changes have been amended, the EDI will be ready for complete use.
Pavilion Roll-out Phase1) Using the above methodology, roll-out the EDI to all pavilions. In addition to the 2G
Ambulatory Ortho and ENT notes, there is also a 2G Ambulatory General note. This note can be used as a general template for Ambulatory specialties that lack specific customizations.
2) After physicians begin to become accustomed to the EDI, begin to add specialty specific instructions using the process mentioned above in the “Collection of Information” section.
Deliverable 2: Discharge Process Re-design
Status board informs
PCT/RN of patient arrival
Olson Discharge Process Re-Design
PCT/RN goes to waiting
room to greet patient and
escort back to room
Patient undresses and
collects valuables in preparation for nursing assessment
RN conducts H/P, starts IV, informs patient of plan and potential
delays
RN informs family that
they may visit with patient
Surgeon and/or
anesthesia may consult prior to case
start
Patient taken to
OR
RN reviews preliminary discharges
instructions/ patient
education material
Pre-Operative-Recommended Process
New Step
Post-Operative-Recommended Process
Patient taken to recovery
room
RN visits patient for
post-op assessment
Status board is updated
from “In-OR” to
“Post-Op”
Surgeon completes discharge
instructions via
PowerChart
Family may visit
when called by
nurse
RN prints discharge
instructions and gives to patient in discharge
folder
RN provides patient
education and manages patient
expectations
RN discharges patient and
informs patient of follow-up
call/survey
Patient remains
in Phase 1 until alert
New Steps
Deliverable 3: Discharge Phone Call Tracking
Feinberg Discharge Phone Call Compliance
50%47%
32%
0%
10%
20%
30%
40%
50%
60%
April May June
Month
Per
cen
t of
Pat
ien
ts C
alle
d
% Called
Olson Discharge Phone Call Compliance
40%
29%
15%
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
April May June
MonthP
erce
nt
of P
atie
nts
Cal
led
% Called
On average 43% of Feinberg patients were called between April and June
On average 28% of Olson patients were called between April and June
Discharge Phone Call Compliance
n=76 n=76
4. Designate one RN the responsibility of assigning call backs
3. Incorporate scripting at discharge: “Thank you for choosing NMH. We will be following your care with a discharge phone call.”
2. Set a goal of 100% follow-up phone call rate
1. Develop a monthly dashboard to track compliance rates across all pavilions
Recommendations for Increasing Discharge Phone Call Compliance
Organizational Impact of Project
Electronic Discharge Instructions
Maximization of current IT investment
Promotes provider and staff satisfaction
Competitive advantage as a Great AMC
Discharge Process Re-design within Olson
Allows the inclusion of family members
Reinforces patient education
Discharge Phone Call Tracking
Additional opportunity to increase patient satisfaction
Potential reduction of re-admission rates
Thank You
Dr. Armen KelikianDr. Rakesh ChandraGoran GavranJennifer BloomquistTia FosterMadge PatykAnne FindeisErma Clark
NMH Senior LeadershipKatrina Van GerpenKaren AndersonAlvin dela CruzMichael ValitchkaSteven ThillElla EchavezSurgical Services DepartmentOlson ASC
Appendix of Supporting Slides
1) ASC overall average Press Ganey score2) ENT and Orthopedics Press Ganey Scores for:• information you received prior to surgery• information given to the patient’s family• instructions regarding home care3) UHC percentile rankings
1) ASC overall average Press Ganey score2) ENT and Orthopedics Press Ganey Scores for:• information you received prior to surgery• information given to the patient’s family• instructions regarding home care3) UHC percentile rankings
Linkage to BPE: Develop a patient experience that includes timely, consistent and accurate information regarding perioperative care for Ambulatory Surgery Center (ASC) patients and families.
Problem: For the baseline period of Q3 FY 09, the overall average ASC patient satisfaction score was 71.4% (very good) in comparison to the overall target of 75.7%. Press Ganey scores indicate lower patient satisfaction with 1) information received prior to surgery (67.4%), 2) information given to the patient’s family (71.5%), and 3) instructions to patient regarding home care (68.3%).
Goal Benefit: Increase ENT and Orthopedics scope questions by 50% VG.
Scope: 12 week pilot focused within Olson ASC Orthopedics and ENT specialties. Post 12 weeks, pilot will be used as template for all NMH ASCs.
Deliverables: 1) electronic discharge instructions containing clear and effective directions for patients, 2) a pre-arrival experience providing procedure specific patient education material and information that sets expectations for the day of surgery and home care and 3)analysis of discharge phone call compliance
Core Team Required: Olson ASC nursing staff and registration, ENT and Orthopedics physician champion, Specialty offices, Information Services-Technology Management staff, Patient Education Department
Linkage to BPE: Develop a patient experience that includes timely, consistent and accurate information regarding perioperative care for Ambulatory Surgery Center (ASC) patients and families.
Problem: For the baseline period of Q3 FY 09, the overall average ASC patient satisfaction score was 71.4% (very good) in comparison to the overall target of 75.7%. Press Ganey scores indicate lower patient satisfaction with 1) information received prior to surgery (67.4%), 2) information given to the patient’s family (71.5%), and 3) instructions to patient regarding home care (68.3%).
Goal Benefit: Increase ENT and Orthopedics scope questions by 50% VG.
Scope: 12 week pilot focused within Olson ASC Orthopedics and ENT specialties. Post 12 weeks, pilot will be used as template for all NMH ASCs.
Deliverables: 1) electronic discharge instructions containing clear and effective directions for patients, 2) a pre-arrival experience providing procedure specific patient education material and information that sets expectations for the day of surgery and home care and 3)analysis of discharge phone call compliance
Core Team Required: Olson ASC nursing staff and registration, ENT and Orthopedics physician champion, Specialty offices, Information Services-Technology Management staff, Patient Education Department
ASC Patient Satisfaction-Striving for 5's through Patient CommunicationASC Patient Satisfaction-Striving for 5's through Patient CommunicationOverview
Key Metric(s):
Sponsor: Karen Anderson, Director-Surgical Services Project/Process Owner: Kelli Clifton, Graduate Administrative Intern Improvement Leader: Michael Valitchka
MilestonesDescription DateDefine 6/15 - 6/29Measure 6/29 - 7/6Analyze 7/6 - 7/13Improve 7/13 - 8/10Control 8/10 - 9/4
MilestonesDescription DateDefine 6/15 - 6/29Measure 6/29 - 7/6Analyze 7/6 - 7/13Improve 7/13 - 8/10Control 8/10 - 9/4
Project Work Plan
Project Tracking Tool
Olson ENT Volume by PhysicianFY'09 (Q1-Q3)
0
20
40
60
80
100
120
140
160
Physician
Vo
lum
e
0.0%
2.0%
4.0%
6.0%
8.0%
10.0%
12.0%
14.0%
16.0%
18.0%
Pe
rce
nt
Olson ENT Volume by ProcedureFY '09 (Q1-Q3)
0
20
40
60
80
100
120
140
160
180
200
Procedure
Vo
lum
e
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
Pe
rce
nta
ge
Key Facts
•40% of ASC patients are surveyed
•30% response rate
•ASC surveys sent within 3 days of discharge
•Avg. Patients seen per month-Olson--Feinberg--Prentice-
•NMH reports % VG
Managing Expectations
Provider Perspective
• Patient receives appropriate discharge instructions
• Patient is aware of follow-up appointments
• Patient arrives on schedule for surgery
• Patient obtains accurate diagnostic testing
Patient Perspective
• How long will I spend in the ASC?
• What foods/medications should I have after surgery?
• When can my family visit me in recovery?
• Why do I have to arrive earlier than my surgery start time?
Great Academic Medical Centers with Electronic Discharge Instructions
Receptionist asks patient to verify personal information and sign advance directives, financial responsibility, personal property forms and health screening form
Receptionist pulls patient packet and gives to patient
ASC Waiting Room-Current Process
Patient arrives at ASC and checks into
Receptionist desk by giving his/her name
Receptionist verifies ID bracelet, places bracelet on patient,
gives family privacy card containing
tracking number and validates parking
Patient told to be seated until called by
Patient Care Technician or nurse
Registration asks patient to verify
personal information, sign advance
directives, financial responsibility,
personal property forms and health screening form
Receptionist greets patient/family,
explains privacy number, gives trifold,
gives information about refreshments location, and directs them to ASC/Olson Registration Area
Registration verifies ID bracelet, places bracelet on patient,
validates parking and gives patient trifold to review while waiting
Patient told to be seated until called by
Patient Care Technician or nurse
ASC Waiting Room-Recommended Process
Patient arrives at ASC and checks into
Receptionist desk by giving his/her name
Staff Responsibilities
Receptionist
Greet patients and familyDirect patients to RegistrationMonitor status board/casesRound throughout the areaCall interpreter services/chaplainDirect families to hospital locations
Registration
Verify patient informationProvide reference for advance directivesValidate parkingOrganize patient packets Assist receptionist with calls when available
Olson ASC Waiting Room Process Map
Pre-Operative-Current Process
Status board informs
PCT/RN of patient arrival
PCT/RN goes to waiting
room to greet patient and
escort back to room
Patient is told to undress and
collect valuables in
preparation for nursing
assessment
Nurse conducts H/P assessment,
starts IV, informs
patient of plan and potential
delays
Nurse informs family that
they may visit with patient
Surgeon and/or
anesthesia may consult prior to case
start
Patient taken to OR
Status board informs
PCT/RN of patient arrival
PCT/RN goes to waiting
room to greet patient and
escort back to room
Patient is told to undress and
collect valuables in
preparation for nursing
assessment
Nurse conducts H/P assessment,
starts IV, informs
patient of plan and potential
delays
Nurse informs family that
they may visit with patient
Surgeon and/or
anesthesia may consult prior to case
start
Patient taken to
OR
Pre-Operative-Recommended Process
If completed, RN reviews preliminary discharges
instructions/ patient
education material
New Steps
Olson Pre-Operative Process Map
Olson Post-Operative Process Map
Post-Operative-Current Process
Patient taken from OR to
recovery room by anesthesia
team
RN visits patient for
post-operative assessment
Status board is updated from “In-OR” to “Post-Op”
Patient remains in
Phase 1 until alert
Family may visit when called by
nurse
Nurse goes over discharge
instructions from
physician
Patient discharged from ASC
Post-Operative-Recommended Process
Patient taken from
OR to recovery room by
anesthesia team
RN visits patient for
post-operative
assessment
Status board is updated
from “In-OR” to
“Post-Op”
Surgeon complete discharge
instructions via
PowerChart
Family may visit
when called by
nurse
Nurse prints completed discharge
instructions and gives to
patient in discharge
folder
Nurse provides patient
education and manages patient
expectations
Nurse discharges patient and
informs patient of follow-up call/survey
Patient remains in
Phase 1 until alert
New Step
Log into Power Chart
Select patient from patient list or by medical record number
Select Notes 2G Tab and then ADD to generate discharge note
Select Encounter Pathway tab, search for note…..Ex. 2G Ambulatory Ortho
Click note name to highlight and “Add to Favorites” for quick accessibility
Double click on note name to open and generate discharge instructions
Click hide structure or show structure to select instructions or preview document
When complete, sign note by selecting ‘Discharge Instructions” as the Type
Discharge Instructions for Medical Staff
Log into Surginet
Select patient from patient list or by medical record number
Select Reports and Summaries
Select Specific Discharge Summary
Print Discharge Instructions for Patient
Discharge Instructions for Nursing Staff
Updating PowerChart Discharge Instructions
If you need to update information within the discharge instructions….
Use the Request to Amend form and send to IS for assistance