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A Value-Based Model for Reduction of Preventable Harm in Medical

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A Value-Based Model for Reduction of Preventable Harm in Medical

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    1. A Value-Based Model for Reduction of Preventable Harm in Medical/Surgical Inpatients

    2. Case #1 58 yr old man following colon resection proceeds to have a massive AMI � Cardiogenic Shock

    3. Case #2 55 yr old morbidly obese woman with sleep apnea undergoes bowel resection complicated by severe aspiration, pneumonia & respiratory arrest.

    4. Case #3 88 yr old female undergoes radical surgery for pelvis tumor. On POD # 2 at 6:45 PM patient developed respiratory distress and decreased oxygen saturation. Surgical rapid response called. SICU attending as well as the surgical PA and residents respond. It is quickly determined that patient requires intubation. Pt is intubated by the intensivist while plans for transfer to SICU are made.

    5. Effective Methods/Factors on Outcome Multidisciplinary focus Critical event training/simulation Effective communication process Physiologically based early warning systems and intervention

    6. Hypothesis & Objectives Building safe hospital systems to improve value-based surgical outcomes is predicated on workflow redesign for dynamic risk stratification, coupled with �real time� mitigation of risk Co-management model for hospitalized surgical cohort Iterative process redesign adaptable to disparate systems Outcome-based; cost-effective = value paradigm Multidisciplinary teams, patient-centered Applicability to medical/surgical adult inpatients

    9. Continuum of Care: Program Description and Domains

    10. Study Design and Methods

    11. Implementation Steps Engagement of Stakeholders Multidisciplinary Structure: - Floor based team building/cohorting - Restructure Hospitalist role/enhance ownership - One CoC MD � weekly rotation Redesign Process Flow - Concurrent multidisciplinary CoC rounds in a.m. - CoC morning report - Hawk rounds, TOC, task assignment, TRT - Real time team and external communication - Creation of PCU Tools - MDRT in Epic - Vocera build out - Mortality analysis, simulation - FCCS training - Protocols, care maps, algorithms

    12. A Day in the Continuum

    13. Rounding Tool Domains

    14. Pilot SCoC: Mortality

    15. Pilot SCoC

    16. Pilot SCoC: Outcome Summary

    17. Validation SCoC

    18. Validation SCoC

    19. Validation SCoC: LOS

    20. Validation SCoC: Readmissions

    21. Hospital-wide CoC: Mortality

    22. Hospital-wide CoC: Mortality

    23. Cost Savings Pilot SCoC Cost saved from decreased LOS in PCU $851,511 - $2,007,388 Validation SCoC ALOS and direct costs by CMS surgical DRG

    24. Summary Hospital Care Delivery Redesign: Real time acuity stratification and mitigation of risk Applicability to disparate hospital systems / patient populations Cost saving outweighs resource requirement Limitations: Not an RCT Administrative data reliance SMR: Constant risk fallacy �Differential measurement error� �Inconsistent proxy measures of risk�

    26. Future Initiatives FCCS course for hospitalists/mid level providers/nurses at GWV Education using simulation of real case scenarios Floor based data on outcomes Readmission analysis Predictive modeling - Mortality analysis - Implementation of SS360 score - Development of risk stratification score for medical pts - Bio markers DRG based protocols/algorithms

    31. Case #3

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