FHA HIIN Readmissions Peer Sharing Webinar: Improving Care - - PowerPoint PPT Presentation

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FHA HIIN Readmissions Peer Sharing Webinar: Improving Care - - PowerPoint PPT Presentation

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FHA HIIN Readmissions Peer Sharing Webinar: Improving Care Transitions through a Discharge Lounge July 24, 2018 Todays Agenda Welcome & Overview How are we doing on Reducing Readmissions? Peer Sharing Presentation: Improving

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FHA HIIN Readmissions Peer Sharing Webinar: Improving Care Transitions through a Discharge Lounge July 24, 2018

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  • 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

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FHA Mission To Care

Hospital Improvement Innovative Network (HIIN)

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The Largest Quality Improvement Initiative in the WORLD!

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5

FHA Mission To Care: 93 Hospitals

Who is in the HRET HIIN?

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  • 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

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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 9.31 HRET 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

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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-18 FL 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

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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 12.64 HRET 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

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Leslie Pollart, Director of Nursing

IMPROVING THE DC PROCESS

Timel eliness LO LOS Volume

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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

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Services

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DISCHARGE VOLUME: DAILY/HOURLY ANALYSIS

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ADMISSI SSION O ORDER ERS S BY TIME O OF D DAY

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Discharge Timeliness: MD order time to Endpoint

Goal is 120 minutes!

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DISCHARGE BY DISPOSITION

72. 72.20 20% 14 14.21% 1% Against Medical Advice ALF Placement Another Health Care Institution Not Defined Skilled Nursing Facility Expired Home or Self Care Home-Health Care Svc Hospice/Home Psychiatric Hospital

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“Vac

Vacat ate t the B Bed ed”

MISSION STATEMENT

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COURTESY LOUNGE

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DC ORDER TO ENDPOINT

ALL DISCHARGES

Average Time 158 min

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DISCHARGE ORDER TO END POINT (FROM DCL)

Average Time 105 min

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DC ORDER TO END POINT: 4TH QUARTER 2016

OBSERVATION UNIT Average Time 93 min

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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 Volume me

DCL Closed for Reno

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COURTESY LOUNGE UTILIZATION : HOME AND HOME HEALTH D/C

JULY 2016 TO DECEMBER 2016

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Average Time in DCL: April 2014 thru May 2015

10 20 30 40 50 60 70

51 44 41 40 31 41 50 52 46 51 61 47 46 55

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Discharge Timeliness: Observation Unit

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DISCHARGE LOUNGE STATISTICS

April May June July Aug Sept Oct Nov Dec 54 43 43 35 35 33 33 36 36 39 39 40 40 37 30 30 101 01 113 113 11 112 121 111 114 71 71 68 68 72 72 Median Order to DCL Median DCL to End

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DC Lounge Utilization & Frequency of Purple Alerts

100 381 382 371 462 350 239 280 383 533 444 642 611 654 609

36 13 12 6 3 9 14 13 14 36 41 33 29 19 13 5 10 15 20 25 30 35 40 45

100 200 300 400 500 600 700 Month Total Purple Alerts

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Discharge Courtesy Lounge

  • Hours of Operation: Monday through Sunday 09am-2130
  • RN & PCA open lounge; then RN is added at 11am
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TRANSITIONS OF CARE TEAM

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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

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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.

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CALL BACK SCHEDULE

Day of Call Case Management Pharmacy Nursing

2 x 7 x 14 x 21 x 28 x

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CONTACT CARDS

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Call backs: Days 2, 5, 7, 10, 14, 21, & 28

TOC TRACKER

Indicates DC to DC clinic

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CALL BACK SCRIPTS BY TIME INTERVAL

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EPIC CALL BACK DOCUMENTATION

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ACUTE MYOCARDIAL INFARCTION

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CHRONIC OBSTRUCTIVE PULMONARY DISEASE

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HEART FAILURE

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PNEUMONIA

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TOTAL HIP/KNEE ARTHROPLASTY

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AVERAGE TIME TO READMISSION (DAYS)

AMI COPD HF Pneumonia Hip/Knee Avg Time to Readmit (Days) 14.5 11.8 15.3 21.7

5 10 15 20 25

14-21 Days

Highest Risk for Readmit

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CALL BACK ATTEMPTS

OCTOBER-DECEMBER 2017

Day 7 Day 14 Day 28 Oct 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

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CALL BACK CONTACTS

OCTOBER-DECEMBER 2017

Day 7 Day 14 Day 28 Oct 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

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QUESTIONS?

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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

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https://fhaawards.secure-platform.com/a/

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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 HIIN@fha.org to request a topic for discussion

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We are here to help! HIIN@fha.org 407-841-6230

Contact Us