Scripps Mercy Hospital Chula Vista

1. Scripps Mercy Hospital Chula Vista Improved Communication Through Multidisciplinary Huddles (MDH) Results in Reduced Patient’s Length of Stay Sussie Pangcog, MSN; Sonja McAllister MSN, CNS, CCRN-K; Carly Blair, RDN; Michele Tsugawa Billand, Pharm.D.; Steve Gilbody, MBA, BSN, RN, CCM; Julia M. King, PT, CEES; Kimberly Rodriguez, BSN March 22, 2019

2. Scripps Mercy Hospital – Chula Vista • 183 Licensed Beds • Emergency Department • General Medicine • Specialties Acute Care Beds • Medical/ Surgical • Oncology • Telemetry/ Step Down • Intensive Care • Maternal Child Health

3. Background • Inpatient length of stay (LOS) nationally averages 5.3 days at a cost of $377.5 billion dollars annually. • In 2017, our community hospital’s LOS was 4.07, below the average however we felt there was still opportunity to improve. • Nurses identified fragmented communication between disciplines as a contributor to LOS.

4. Background • Historically, various methods of communication trialed • 2013- 2015 Care Management Rounds • 2016 Patient Care navigators converted to Care Managers, floor based, case load 20-25 patients • 2017 • Kardex in each chart • Ingenious Med Bills (IM Bills) at SD only • Bedside huddle for all new admissions (SD) • Centricity EHR

5. NEXT • Exceptional care, for every patient, by every caregiver, every time • December 2017 Model Care is launched at Mercy SD as System Pilot unit • January 2018 Mercy CV 4th floor launched pilot Model Care • Multidisciplinary Huddles an element of Model Care

6. Multidisciplinary Huddle (MDH) • Purpose • To improve the patient’s experience and reduce the duration of a patient’s stay in the hospital by improving communication among disciplines and identifying barriers to their discharge • Outcome • Specific, clear next action (What, Who, and by When) to progress the patient’s care • Shared understanding among care team members about the patients on the unit and their daily needs • Strive for 100% of patients on the unit are reviewed, 7 days a week

7. MDH • Structured • Consistent • Time, Location, Attendees, Report • Identify & discover barriers to discharge • Communicate with team to address barriers

8. MDH • Standardized daily time – 1000 • Prep work • MD Schedule

9. MDH Standard Work

10. MDH Dedicated Board

11. MDH Report

12. MDH Evolution of Engagement • Major Change for everyone • Cautious engagement by all disciplines • Time consuming • Staff availability • Physician buy-in and schedules

13. MDH Evolution of Engagement • Scripps committed to improving patients’ care • Staff including all disciplines committed to improving communication • Physicians committed to creating schedule that hospitalists would keep • MDH implemented with structure, discipline and accountability

14. MDH Significance • Utilizing MDH, interdisciplinary communication has improved and LOS has decreased. • A Charge Nurse leading the structured MDH has improved the average LOS by 10%. All disciplines involved believe that MDH is a valuable venue for discussion as well as discovery and early mitigation of patient issues.

15. MDH outcome • All disciplines finding MDH is “doable” • 30 min time commitment met • Early Collaboration • Follow-up more quick for timely discharge • All disciplines involved in creation of plan of care • Proactive and better understanding of patient’s needs

16. MDH Significance

17. MDH Team Comments

18. Next Steps • Weekend coverage same as weekdays • Floor based Case Managers and Social Workers • Physical Therapies floor based • All Patients included

19. Acknowledgements • Sister-hospital, Mercy SD • Partners in Care – all our disciplines • Physicians, for close collaboration to make it work • Patient Care Managers

20. References • www.healthcatalyst.com • www.beckershospitalreview.com

21. Contact Information • Sussie Pangcog, MSN • Sr. Director Patient Care Services • Pangcog.Sussie@Scrippshealth.org • Sonja Mc Allister, CNS • McAllister.Sonja@Scrippshealth.org