Preparation for Discharge Day Judith Ann Tinelli MSN, RN, ONC, CNL, CRRN Rehabilitation Nurse Clinician Teresa Robosson BSN, RN PPS Coordinator UPMC St Margaret
12/13/2011 The Goal of Rehab • Generally, the goal of the Inpatient Rehabilitation Facility should be the patient safely returning home or to a community based environment.
12/13/2011 UPMC St Margaret Performance Improvement Plan • Education of nursing staff November 2010 • Implement Preparation for Discharge Day • Multidisciplinary Preparation for Discharge Day 10am-10am Procedure and Functional Forms • All FIM scores entered from 10am the day prior to discharge through 10am the day of discharge are the final FIM scores which navigate to the IRF-PAI, which is the Medicare assessment which drives rehab reimbursement • Evaluate results of FIM and CMI based on benchmarks
12/13/2011 Report Card Patient • MULTIDISCIPLINARY FORM INDEPENDENCE DAY • Name Weightbearing Status • Device Precautions • • • Ambulation: Level of Assist Comments: • • Bed Mobility: Level of Assist Comments: • • Sit ←→ Stand: Level of Assist Comments: • • Toilet Transfer: Level of Assist Comments: • • Toileting: Level of Assist Comments: • • UB Dressing: Level of Assist Comments: • • LB Dressing: Level of Assist Comments: • • Grooming: Level of Assist Comments: • • Bathing: Level of Assist Comments: • • Eating: Level of Assist Comments: • • Swallowing: Level of Assist Comments: • • W/C mobility: Level of Assist Comments: • • Comments: • • Nrs: Date • • PT: Date • • OT: Date • • SLP: Date • • MD: Date
12/13/2011 Certificate of Graduation-sticker
12/13/2011 FIM to FIM change • How did we do? • What does this look like on a spider graph with the 18 areas of FIM? • How much assistance does the patient need? • 56 FIM on admission (Burden of Care is equal to >4hrs/day) • 92 FIM on discharge (Burden of Care is less than one hour/day) • Good discharge plan
12/13/2011 Spider Graph
12/13/2011 Admission Functional Independence Measurement Scores Admission FIM 2010 Admission FIM 2011 1st quarter 2012 Admission FIM 2012 50 60 70 80
12/13/2011 FIM Change FIM change FIM change 2010 FIM change 2011 FIM change 1st quarter 2012 FIM change 2012 0 5 10 15 20 25 30
12/13/2011 Length of Stay Efficiency LOS efficiency LOS 2010 LOS 2011 LOS efficiency 1st quarter 2012 LOS 2012 0 1 2 3
12/13/2011 1.4 Case Mix Index 1.2 1 • Case Mix Index (CMI): The Rehab patient’s acuity of care is 0.8 determined by Physician documented admission Rehab 0.6 diagnosis, Co-morbid conditions SMH and team documented admission Region FIM assessments. 0.4 Nation • See graph comparing SMH CMI to regional and national 0.2 benchmarks. • Accurate documentation is 0 important for reimbursement, patient progress and outcomes and appropriate staffing levels.
12/13/2011 Press Ganey Patient Satisfaction Scores-compare scores nationally
12/13/2011 Community Discharge • 78.7% discharged to the community setting average over the past 3 years • July of 2012 82.1% • 80.8% average for the region over the past 3 years
12/13/2011 Outcomes • 98 th percentile on Press Ganey • Length of stay efficiency in 2010 2.25 and is now 2.79 in 2012. • FIM change increased from 18 in 2010 to 25.4 in 2012. • Admission FIM was 73.3 in 2010 and is now 63.2 in 2012. • Our multidisciplinary committee has not only increased the functional status of our patients for discharge, but has also increased our patient satisfaction rates with a truly interdisciplinary effort.
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