pursuing high value healthcare optimizing laboratory testing webinar #6 july 16, 2015 1
TRANSCRIPT
Agenda
WelcomeData Team Updates
Current data and reports Discussion
Team Status Reportso Progress/Activities Since Learning Session
Phase 2 of Collaborative Meeting Time Reminders●Next Steps
Action Period
2
Our First Collaborative: Global Aim
We aim to reduce harm to patients and conserve system resources by optimizing the use of laboratory tests for patients cared for in our region’s hospitals. We will use a collaborative approach considering the best medical evidence and quality improvement science. It begins with an evaluation of current test ordering profiles and patterns followed by an organized plan to optimize testing and ends with a plan to sustain these practices. By doing this we expect to reduce cost and improve satisfaction and quality of care for patients and the health system. It is important to work on this now because as health care professionals we can play an important role in health care reform by designing more patient-centered, efficient and high value inpatient care.
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Data Update
Site visit findingsInstitution specific data reportsConsolidated database reportsNext steps
Project Target Population
All adults with an inpatient hospital stay > 24 hours in length, excluding maternity, inpatient psych and swing bed patients
What does “inpatient” mean? When does admission time start?Inpatient > 24 hoursER visit > 24 hours?Observation bed > 24 hours?Same Day Surgical care > 24 hours?ER Observation Inpatient?
Project Target Population
All adults with an inpatient hospital stay > 24 hours in length, excluding maternity, inpatient psych and swing bed patients
Excluding PatientsMaternity & childbirth related, excluded using MDC codes 14 & 15 or
DRG codes 765-795Inpatient psych, excluded prior to data submission when possible.
Additionally, excluded using DRG code 885Swing bed, excluded using discharges with no DRG code assigned
Dropping Missing DRG codes
Swing bed patients are typically not assigned a DRG codeWhat other patients are typically not assigned a DRG code?
Observation only patients? Other?
What patients might we inadvertently drop if we exclude all discharges with a missing DRG code? DISCUSSION
Defining Length of Stay
Length of Stay in hours = (discharge timestamp – admit timestamp)
Length of Stay in CDC days = (discharge date – admit date)
Length of Stay in calendar days = ((discharge date – admit date) + 1)
Defining Length of Stay
For example, suppose a person gets admitted at 10:02am on June 2nd and discharged at 4:10pm on June 3rd
Length of Stay in hours = (6/3/2014 16:10 – 6/2/2014 10:02) = 29.13 hours
Length of Stay in CDC days = (6/3/2014 – 6/2/2014) = 1 day
Length of Stay in CDC days = ((6/3/2014 – 6/2/2014) + 1) = 2 days
Defining Length of Stay
For example, suppose a person gets admitted at 10:02am on June 2nd and discharged at 4:10pm on June 3rd
But what does “admitted” mean?Was the patient admitted to the ER at 10:02am?Was the patient assigned a bed as on “observation” patient at
10:02am?Was the patient admitted as an inpatient at 10:02am?
Defining Admit Time
1. Identify individual discharges using a unique visit number in the admission data file, unique visit
number
2. Link all labs associated with an individual discharge unique visit numbers
Sometimes the unique visit number is in the Lab data file Sometimes we link on MRN and dates of service
3. Labs are associated with a visit if they are within 24 hours of the available admit timestamp
Labs Within 24 hours of Admit Timestamp
Goal: to ensure we obtain labs that were collected when a patient was in the ER or an observation bed prior to being admitted as an inpatient If labs were collected within 24 hours prior to the available
admit timestamp, the earliest collection time is used as the “admit time” when calculating length of stay
For example, suppose a person goes to the ER on June 2nd at 6:11am and has a CBC drawn at 8:01am. The patient then gets admitted as an inpatient at 10:02am on June 2nd and discharged at 4:10pm on June 3rd. The “admit time” used to calculate length of stay will be 6/2/2014 08:01.
Labs Within 24 hours of Admit Timestamp
By only including labs that were collected within 24 hours prior to the available admit timestamp, what issues might come up?
If a patient has labs for an elective surgery done 7 days prior to the admission they will not be included. BUT if the are done the day before surgery they might be….. Other concerns? DISCUSSION
Next Steps
1. Finalize length of stay definitions2. Finalize inclusion/exclusion criteria3. Support sites to continue monthly data uploads4. Define monthly DRG severity values5. Include LFT and Cardiac Biomarker lab tests6. Support Year 2 of the Collaborative (explore lab values?
Explore DRG specific ordering patterns?)
Team Progress Reports
RRMCBrattleboroNVRHBenningtonPorterDHMCCVMCUVMMC
Any updates from the teams to share on advances since our Learning Session at Dartmouth?
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Learning Session 1Oct. 25
8:30 to 3:30
LearningSession 4Jun. 9 TBD
8:30 to 3:30
Learning Session 2
Jan.14, TBD8:30 to 3:30
Kick-Off Week 1
Sept 10, 2PM
LearningSession 3
Apr. 14 TBD8:30 to 3:30
Action Period5-6 weeks
Conference Call /
WebinarNov 19,
2PM
Conference Call /
WebinarDec 17,
2PM
Conference Call/
WebinarFeb. 18,
2PM
Conference Call /
WebinarMar 24,
2PM
Conference Call /
WebinarMay 12,
2PM
Continuous Coaching/Faculty Support
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