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Readmissions Interventions and Shared Learning. Stephanie Sobczak, MS, MBA Improvement Advisor WHA. Courtesy Reminders: Please place your phones on MUTE unless you are speaking (or use *6 on your keypad) Use *7 to UN-MUTE
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Readmissions Interventions and Shared Learning Stephanie Sobczak, MS, MBA Improvement Advisor WHA • Courtesy Reminders: • Please place your phones on MUTE unless you are speaking (or use *6 on your keypad) • Use *7 to UN-MUTE • Please do not take calls and place the phone on HOLD during the presentation. • Thank you!
Today’s Call • Past 30 Days • Announcements, etc. • Hospital Stories • Intervention Selection • Small Tests of Change • Barriers and Successes • Measuring Processes (moved to the end) • Next 30 Days
Midpoint Survey Feedback Did you determine your “tipping point”? What proportion?
Midpoint Survey Feedback Did you try 2-3 tests of an intervention? What are the barriers to testing?
Announcement Care Transitions Regional Workshops Designed to bring rural stakeholders together to improve care transitions in a defined area: • October 9, Viroqua • October 16, Rice Lake If there is interest, these one-day workshops will be held in other communities (NE, SW, etc)
INTERACT II for Nursing Homes Update - Now in it’s third month: • Case Review of ER Transfers and Hospital Readmissions • Implementing SBAR • Early Warning Tools for front-line staff • Measuring Readmission Rates • PDSA Cycles Jody Rothe, Meta Star & Stephanie Sobczak, WHA are the instructors
NEW! HRET’s ReadmissionsRace! • The Goal: Wisconsin and 33 other states are going to reduce readmissions by 20% between now and December 31, 2012. • Additional webinars (see the Wednesday Weekly on the Quality Center) – not required • HRET is looking for Wisconsin hospitals to share their results on webinars, and in person (in Indianapolis, in November).
Questions, so far? • Courtesy Reminders: • Please place your phones on MUTE unless you are speaking (or use *6 on your keypad) • Use *7 to un-MUTE • Please do not take calls and place the phone on HOLD during the presentation. • Thank you!
Ministry Good Samaritan Health Center and WHA Partners For Patients 30 Day Readmission Initiatives
Partners for Patients All-Cause Readmissions Initiative • Colleen Schuett, RN, CPHM Clinical Quality Improvement Specialist • Ministry Good Samaritan Health Center is a 25 bed Critical Access Hospital located in Merrill, Wisconsin. A town with a population of approximately 10,000
Project AIM Statement • To reduce hospital readmissions by 20% or more by December 2013.
Measures Initiated • QI review of written discharge instructions to assess for: • Follow-up appointments scheduled at discharge • Discharge instructions appropriate for diagnosis • Patient education provided throughout hospital stay • Review of 30 day readmission charts for same diagnosis to identify trends
Measures continued • The process measures that we are tracking are with our post-hospital phone calls: Did patient understand their discharge instructions, and were follow-up appointments made for them prior to discharge.
Measure Results • Because these measures have only been in place for a month, there is not adequate information to determine outcomes at this time. • Ongoing evaluation of measure initiatives is essential, and identification of trends in readmissions will determine action planning.
Next Steps • Analyze the type of patient that is readmitted for how many live at home vs nursing home. See if there are opportunities to work closely with our local nursing home to help reduce this number. • WHA educational opportunities to increase awareness and support for continued success
Rusk County Memorial Summary SUMMARY: Based on our finding with our tests using tools for documentation we “started over”. Restarted small by using 2 RN’s as nurse champions to use the tools and make recommendations for improvements, adjustments, etc. to make tools user friendly. We are currently monitoring use of the DKAT and auditing the teaching documentation EMR form. Follow-up phone calls have been very successful in answering questions post-discharge and reminders for follow-up appointments
Aurora West Allis Medical CenterFocus on: Hi-risk patients =>65 years old1 Month - readmitted patients , one unit
Kindred Hospital MilwaukeeIDT Members/Staff • Contacting patients who were discharged to home to ask how they are doing, if they understood their dc instructions, will they be going to their physician for f/u & if there are any questions.
Kindred Hospital MilwaukeeIDT Members/Staff • Next meeting with IDT to dissect the dc process, barriers, what could go better. What does each dept need? • Surveys to staff as to what they feel the dc process needs, what could be improved. Implementing several items based on this information:
Option 2 Kindred Hospital MilwaukeeIDT Members/Staff
Memorial Medical CenterAshland, Wisconsin • 25 bed critical access hospital with a 10 bed psychiatric distinct part unit • Located on the south shore of Lake Superior, with two adjacent Native American reservations • Significant elderly population • Good community services for transportation, in-home support, assisted living and long term care
Scheduled Appointment After Initial Discharge to Long-Term Care
Memorial Med Center -- Ashland Staff Assessment: What do you think are the most common factors resulting in a patient being readmitted? • Discharged from inpatient setting to home too soon. • Patient not able to care for themselves at home. • Family not able to care for patient at home. • Pain management problems. • Patient not taking medications correctly; prescriptions not filled. • Poor adherence to discharge plan. • Management of infectious disease. • Reluctance to make lifestyle changes and poor compliance with treatment plan. • Lack of chronic disease management
Staff Assessment:Please describe what you think can we can reasonably do to prevent or minimize readmissions? • Assess the patient’s ability and willingness to adhere to a treatment plan outside of the hospital setting. • Make referrals (e.g., social services, public health) to achieve better outcomes. • Use 24 to 48 hour follow-up calls to assess adherence and effectiveness of current treatment plan and recommend changes or referrals. • Schedule follow-up appointments with the patient’s physician within 7 days of discharge for those at high risk for readmission • Focus on education with patient and significant others. Start early and reinforce key issues, e.g., medications, disease management.
Plan / Interventions • Refine data collection to include discharge destination for initial admission and readmission • Partner with Long Term Care to improve transitions of care • Develop risk stratification, i.e., high risk and low risk for readmission. • For high risk patients: schedule follow-up appointments within 7 days of discharge and conduct post-discharge phone call 48-72 hours post d/c • Evaluate interventions and adjust as indicated
Partners for Patients Readmissions Data Update on Outcome Measures Update on Process Measures
Outcome Measures N = 67 hospitals Median = 8.7%
How much do we have to improve? • What was your hospital’s baseline numerator? Numerator over 6 months = 120 Less 20% = 96 Readmissions to reduce per month (divide by 6) = 16
Process Measures % of Patients discharged with scheduled appointments. % positive HCAHPS – Patient Satisfaction with Discharge Instructions % of Patients discharged to home Receiving a Follow-up Phone Call within 3 calendar days % of Patients Demonstrating a Complete Understanding of Discharge Care Plan (DKAT) % Discharged Patients with Transition Record Transmitted to next site of care within 24 hours. One is required (unless you are in maintenance mode)
