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

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

Today’s Agenda • 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

FHA Mission To Care Hospital Improvement Innovative Network (HIIN)

The Largest Quality Improvement Initiative in the WORLD!

Who is in the HRET HIIN? FHA Mission To Care: 93 Hospitals 5

Readmissions Regional Discussion Forums • 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 – 30 Day All Cause 12.0 10.0 8.0 Rate per 100 6.0 4.0 2.0 0.0 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 Effective date: July 20, 2018

Readmissions – Medicare 16.0 Baseline = 13.59 14.0 12.0 10.0 Rate per 100 8.0 6.0 4.0 2.0 0.0 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 Effective date: July 20, 2018

Readmissions – Medicare 16.0 14.0 12.0 10.0 Rate per 100 8.0 6.0 4.0 2.0 0.0 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 Effective date: July 20, 2018

IMPROVING THE DC PROCESS Leslie Pollart, Director of Nursing Volume LO LOS Timel eliness

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 County 1 • Largest provider of acute care inpatient services in Broward County 1 • Comprehensive Stroke Center • Adult Heart Transplants 1 Source: Broward Regional Health Planning Council, One Year Ending December 2014

Services

DISCHARGE VOLUME: DAILY/HOURLY ANALYSIS

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

Discharge Timeliness: MD order time to Endpoint Goal is 120 minutes!

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

MISSION STATEMENT “ Vac Vacat ate t the B Bed ed ”

COURTESY LOUNGE

DC ORDER TO ENDPOINT ALL DISCHARGES Average Time 158 min

DISCHARGE ORDER TO END POINT (FROM DCL) Average Time 105 min

DC ORDER TO END POINT: 4 TH QUARTER 2016 OBSERVATION UNIT Average Time 93 min

DISCHARGE LOUNGE VOLUME DCL Closed 1250 for Reno 1200 1150 1100 1050 1000 950 me Volume 900 850 800 750 700 650 600 550 500 Jan April May June July Aug Sept Oct Nov Dec Feb Mar April May June July Aug Sept Oct Nov Dec '17 Volume 769 847 879 839 954 952 1035 895 964 1108 1152 1191 1052 1082 1025 1003 1198 1117 1199 1099 1112

COURTESY LOUNGE UTILIZATION : HOME AND HOME HEALTH D/C JULY 2016 TO DECEMBER 2016 25

Average Time in DCL: April 2014 thru May 2015 70 60 61 50 55 51 52 51 50 46 47 40 46 44 41 41 40 30 31 20 10 0

Discharge Timeliness: Observation Unit

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

DC Lounge Utilization & Frequency of Purple Alerts 700 45 654 41 611 609 40 600 642 36 36 35 33 500 533 30 29 462 444 400 25 381 383 382 371 20 350 300 14 280 15 19 13 14 12 200 9 13 239 10 13 100 100 5 6 3 0 0 Month Total Purple Alerts

Discharge Courtesy Lounge • Hours of Operation : Monday through Sunday 09am-2130 • RN & PCA open lounge; then RN is added at 11am

TRANSITIONS OF CARE TEAM

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

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.

CALL BACK SCHEDULE Day of Call Case Management Pharmacy Nursing 2 x 7 x 14 x 21 x 28 x

CONTACT CARDS

TOC TRACKER Call backs: Indicates DC to DC clinic Days 2, 5, 7, 10, 14, 21, & 28

CALL BACK SCRIPTS BY TIME INTERVAL

EPIC CALL BACK DOCUMENTATION

ACUTE MYOCARDIAL INFARCTION

CHRONIC OBSTRUCTIVE PULMONARY DISEASE

HEART FAILURE

PNEUMONIA

TOTAL HIP/KNEE ARTHROPLASTY

AVERAGE TIME TO READMISSION (DAYS) 25 20 14-21 Days 15 Highest Risk for Readmit 10 5 0 AMI COPD HF Pneumonia Hip/Knee Avg Time to Readmit (Days) 14.5 11.8 15.3 21.7 0

CALL BACK ATTEMPTS OCTOBER-DECEMBER 2017 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Day 7 Day 14 Day 28 Oct 100% 84% 93% Nov 100% 95% 98% Dec 100% 90% 87% Oct Nov Dec

CALL BACK CONTACTS OCTOBER-DECEMBER 2017 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Day 7 Day 14 Day 28 Oct 69% 50% 79% Nov 77% 60% 71% Dec 84% 55% 49% Oct Nov Dec

QUESTIONS?

Improving the Flow of Information - EDie ED as an Island ED as a Bridge Post-Acute PCP In-Patient • ED is focused primarily on • ED is intrinsically connected to efficiency and is only concerned entire healthcare enterprise and is with acute care episode focused on items beyond efficiency • ED and hospital at large view as • ED collaborates to help prevent separate from the larger care readmissions, avoid preventable continuum admissions, and promote care coordination

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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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