TEAM BASED CARE EVENT B E F O R E A F T E R HUDDLES AND CREATING - - PowerPoint PPT Presentation

TEAM BASED CARE EVENT

B E F O R E A F T E R

HUDDLES AND CREATING TEAMS

ROLES AND RESPONSIBILITIES

Clinic: Adult Subspecialty Clinic Goal: Ensure everyone is working at the top of their scope. Role/Responsibility Provider RN MA Clerk Charge RN Social Worker Planning X X X X x X Coordinate Huddle x Schedule/Reschedule Appointments sometim es X Work with patients

• n walk-in requests

x X x x Incoming and Outgoing Referrals x x x Reminder Calls x Medication Refills x x Follow-Up Care x x x Teaching x x * Med Administration x x Out Reach x x Problem Solve x x x x x x Coordinate Care x x x Delegate x x x Interpret lab results x x Document x x x x x x Triage Referrals x x Prior Authorizations x x VS, Rooming x x

Role/Responsibility Provider RN MA Clerk Charge RN Social Worker Procedure Set-Up x Instrument cleaning x EKGs/Pulse Ox walk x Specimen collection x x x Telephone orders x x Complete AVS x Follow AVS/discharge x x Set-up Transport x x Diagnostic scheduling x Assignments for day x Return phone calls x x x Stock exam rooms x Order supplies x x x Transport to ED/Hosp x x Provide information, direction, guide x

BEFORE THE INTERVENTION

Same p pre-op p p practi tice ces No formal c commun unication po post-op unt until f follow up up appo ppointment Frequent frustrations for pa patients a and nd pr providers at po post-op appoi

• int

ntment nt. Comp mpliance i e issues es Instru ruction/Medication c confu fusion No-shows ED vi visits

ENGAGEMENT AND LEADERSHIP

Start w with h little wins o

• n quality i

improvement Practices/Champions ne need t tools t to do the work Something a a clinician h has been n want nting to do for a a long ng t time Use ideas of

• f research or
• r publishing papers t

to

• mo

motivate c clinicians Comp mplaints or frequ quent c calls from p m patients indicates es s somet ething i g isn’t ’t r righ ght Star art smal mall an and even entual ally exp xpan and Ask q que uestions a about ut their b beliefs in w n what w we waste $ on n in n healthcare

THE PROJECT GOAL AND PROCESS

Impr prove our ur po post-operative c commun unication w within the ENT clinic f for our ur ambul ulatory surg rgical p patients Phase I: I: Pos

• st-operative E

ENT N T Nurse Calls ls Every am ambulat atory surge gery pat atien ent c cal alled ed on PO POD#1-3. 3. Eac ach cal all wi with s stan andardize zed objec ectives: Check in with p h patient status Review d discha harg rge instru ructions Repeat t the discharge me medication

• n recon
• nciliation
• n

Co Conf nfirm po post-op

• p a

appoi

• int

ntment nt

METRICS

Errors Discovere red/Corre rrected Postop C Clin inic ic N No-shows ED/ D/UC v visits w within 14 days po post-op Use o

• f after-hours N

Nur ursing Line ne *Unintended ed items ms: : align gnmen ent o

• f discharge

ge i instructions

RESULTS

618 o

• ut

ut-pt surg rgeri ries Dec16-Sept17 96 ( (15.5%) pa patients una unable to b be reached by ph phone Total suc uccessful po postop ph phone calls: 5 522

DISCOVERIES AND OUTCOMES

Discha harg rge instru ruction errors Medication

• n error
• rs

Po Post-op s show w rat ates es Avoidable le E ED visits Financial i imp mplications Nur urse l line ne Provi vider r and S Staff s f satisfaction Patient s t satisfa faction ………………………………… …………………………………. ……….and nd i it’s t the right t thing ng to do!

SPREAD

Healthy c compe petition Recogni nition

• n

Or Orth tho cl clinic c and oth thers rs Le Lesson

• ns l

learned Cul Culture o

• f r

reduc ucing cost/utilization Adding t to the pr project

IDEAS FOR ENGAGEMENT

Specialty Practice: Surgery Clinic Date: 2/12/18 AIM Statement: Our aim is to come up with a solution to decrease our NO SHOW rate. By doing that we are trying to find ways to have our patients more engaged with their medical care and implementing options for lines of communications. What change tactic through TCPi have you been working on? 1.1 Patient and family engagement 1.1.3 Collaborate with patients and families: Actively engage patients and families to collaborate in goal setting, decision making, health related behavior and self-management. Metrics associated with what you are working on in your clinic? Clerk’s: Do reminder calls 1-2 days prior to appointments. By doing that they are now identifying patient transportation/capability to show to there appt. RN’s: Making sure appointments are schedule before patient leaves the exam rooms. HCP’s: Offering My chart as an option for reminder’s of appointments and or options to schedule there appointments. What was the process? How did it start and how did it end? Clerks offer My chart APP at the initial of registration process and confirm/update phone number’s for any future calls, HCP’s will offer my chart in exam room at check in process. By engaging our patient to there health care we are informing them about the benefits and advantages they would getting by signing up for My Chart. Such as having the ability to see lab results, requesting Rx refills, sending messages to provider and scheduling/rescheduling and canceling non needed future appointments. 3/20/18 Our No Show Rate has decreased: No Show Rate for 1/1/18 to 1/31/18 18% No Show Rate for 2/1/18 to 2/28/18 13%

A NEW CONCEPT WAS NEEDED

Frustra rations with h referr rrals both primary c care and specialty care Cl Close the l loop p – 18 18% Non-collaborative c e care Patients no not und understanding referral s set up, up, care pl plan, n, e etc Clini nicians ns not

• t g

getting ng what they n need A prob

• blem with access

Communi unication

• n

HOW?

Ch Chose 1 metric t to d drive c chang nge w with spe pecialty In Increased e education

• n and f

fields in t the r referral Cr Created a a pr process for pr pre-cons nsul ultation e

• n exchang

nge E-cons nsul ults Le Leadership b buy-in in Dat ata Work rkgroups with h action Sur urveys about ut barriers t to care Patient nt s satisfaction s

• n surveys

ys ACP CP S SAN H HVCC CC

A SYSTEM OF CHANGE

Steering Committee (TBD)

Care Coordination + TOC DHMP PCSP PCMH Appointment Center ACS Referrals Education + Sustainability Community Partnerships

Health

Neighborhood

Steering Committee

Medical

Neighborhood

IT REALLY IS A JOURNEY

Cl Clinical q que uestions Defini nitions

• ns of care

Specialty f flyers Referral g guidelines Cl Close the l loop Th The v voice o

• f t

the c cli linician Ac Access/Commu mmunication In Invol

• lvement

Pr Prep epar aring f g for APM APMs