Improving Safety In the ICU - Download as PowerPoint by hcj

VIEWS: 18 PAGES: 23

									  Building the Cross
Continuum Collaborative
Baystate Medical Center

Stephanie Calcasola, RN, MSN, RN-BC
     Susana Hall, RN, BSN, MBA
       Ruth Odgren, RN, MS
•   680 bed tertiary care referral center ( ~1M)
•   Flagship of Baystate Health
•   42 k admissions/year
•   Annual surgical volume: 29,043
•   Western Campus of TUFTS
•   Member CoTH, 9 residency programs/244 PGs
•   1200 member medical staff, 206 faculty MDs
•   Level 1 Trauma Center
•   IHI Mentor Hospital (SCIP/AMI/HF/HAPU/VTE)
•   Magnet facility –re designated 2010
Quality Accomplishments
           STAAR Collaborative Aims
Reducing re-hospitalizations goal for 2010, 2011
  • Threshold: Implement a standardized discharge
    process for heart failure patients
  • Target: Decrease heart failure re-hospitalizations by
    15%
  • Maximum: reduce heart failure re-hospitalizations by
    30%
Makes business sense to be proactive in light of:
  • Upcoming changes regarding healthcare
  • Throughput and capacity issues
  • Right thing to do for patients & families
Study Says US Hospitals Fail To Reduce Avoidable Readmissions.
• Bloomberg News (9/28, Wechsler) reports, "US hospitals risk cuts in
   Medicare payments next year after failing to reduce avoidable
   readmissions, a Dartmouth Atlas Project study showed." The study,
   by tracking "10.7 million discharges at 1,925 hospitals from 2004 to
   2009,...found that readmissions of elderly patients within 30 days of
   a hospital stay have remained the same or increased." And "the
   Centers for Medicare and Medicaid Services in Baltimore plans to
   cut payments by 1 percent to hospitals with excessive rates starting
   in fiscal 2013."
•        The Pittsburgh Tribune-Review (9/28) reports, "Readmission
   rates for Medicare patients ages 65 and older within 30 days barely
   changed from 2004 to 2009." Study author Dr. David C. Goodman
   commented, "For a long-standing problem, not much progress has
   been made." National Journal (9/27, Fox) also covers the report.
•   Deb Hawkes RN -Unit Manager Springfield 3 Oncology
•   Laurie Kaeppel RN / Deb Hawkes RN – Springfield 3 Medicine
•   Carol Morrison RN – S4 Case Manager
•   Brenda Krumpholz RN – S3 M Case Manager
•   Bonnie Geld MSW - Director Care Management
•   Maria Giordano, RN – Assistant Nurse Manager, Daly 5A
•   Carlo Real RN /Jodi Kashouh RN - Splfd 4 Short Stay Cardiology
•   Gini Staubach RN -Assistant Director Critical Care & Cardiology PCS
•   Ann Maynard RN -Director ED
•   John Santoro MD -Vice Chair, Chief Emerg Svcs
•   Surinder Yadav MD - DHQ /Attending Hospitalist
•   Carol Richardson MD - Associate Med Director Hospital Medicine
•   Donna Borah RN Director Hospital Medicine Program
•   Ruth Odgren RN President BVNA&H
•   Aaron Michelucci PharmD, Assistant Director, Clin Pharm
•   Regional Western Mass Cross Continuum Partners
•   Stephanie Calcasola, RN Director of Quality
•   Win Whitcomb,MD, Medical Director of Healthcare Quality
•   Susana Hall, RN Director of Post Acute Care Services
•   Cara Kenny, RN, S1 Clinical Educator
Cross Continuum
Regional Meetings
Cross Continuum Invite
                  Planning for
           Cross Continuum Meetings

•   Regularly scheduled, advance notice
•   Geographically neutral meeting location
•   Continental breakfast
•   Timely agenda/attachments
•   Ongoing and frequent communication
•   Topics of varied and cross sectional interest
                        9
              Objectives
•   Education dissemination
•   Networking
•   Shared Stories/shared commitment
•   Relationship/partnership building
•   Readmission prevention collaboration
               Keys to Success
 Persistence and reinforcement/high visibility
 Senior leader support
 Multidisciplinary cooperation & collaboration
   • Accurate, timely and relevant data
   • Communicate – flexibility
   • Right people
 Willing to try changes and take a risk
 Develop reliable systems
 Incorporate into workflow
   • Make changes easy => transparent => meaningful

   Make The Right Thing The Easy Thing
           Baystate
All-Cause 30-Day Readmissions
      Next Steps/Priority Focus
 Standardization of patient education tools (HF, AMI, PN,
  Stroke, COPD zones) among cross continuum regional
  partners
 Increase frequency of meetings with cross continuum
  regional partners. Shift from primary knowledge sharing
  to work groups and integrated projects.
   • 3026 grant partner
   • Interact survey (post acute facility survey on readmisson
     patterns)
 Pilot med rec/teaching/on original pilot unit with
  pharmacists (August, 2011)
 Submitted letter of intent for Partnership for Patients
 Spreading the methods of Ask me 3/teach back
  throughout organization. Web based training for all
  nurses fy 2012
MHA - STAAR Fall Learning
Session

                                  October 11 & 12, 2011



Ruth Odgren, RN, MS
President Baystate VNA & Hospice
Senior Executive for PAC Relationships, Baystate Health
Ruth.Odgren@baystatehealth.org
      Baystate VNA & Hospice (BVNAH)
          STAAR INVOLVEMENT

• 2008
  ─Focus – Patient Centered Care of those with
   Heart Failure (HF) as 1o or 2o diagnosis

• 2009
  ─Hired part time Heart failure Clinical Nurse
   Specialist
  ─Developed protocols
  ─Incorporated use of telemonitoring
  BVNAH STAAR INVOLVEMENT (Cont.)


• 2010
  ─Implemented use of HF Zones, ASKME3 and
   Teach Back
  ─Coordinated patient care with BMC HF Unit
   Staff
  ─Began subsidy program for uninsured and
   underinsured HF patients
  BVNAH STAAR INVOLVEMENT (Cont.)


• 2011
  ─Began journey to educate and certify all home
   care clinicians in Integrated Chronic Care
   Management (ICCM)

  ─By end of year, 90% of staff to complete the
   ICCM Program (currently at 60%)
  BVNAH STAAR INVOLVEMENT (Cont.)


• Results – All cause HF readmissions

   2008         41% (OCS data)
   2011         21% (internal STAAR
                Data)
• CMS Home Care Compare Data – All cause
  readmissions rate for all diagnoses is 23%
  ─ This is lower than regional, state & national results
                Interact Survey Results
            Transfers back to Acute Hospital


%
    18
    16
    14
    12
    10
    8
    6
    4
    2
    0
         Sunday   Monday   Tuesday   Wednesday   Thursday   Friday   Saturday
             Authorization for Transfer


                            Q16. Who authorized the transfer?

30.00%
                                         24.90%    25.40%
         23.80%
25.00%

20.00%                  16.90%
15.00%

10.00%                                                                               7.90%
5.00%                                                                1.10%
0.00%
         Attending   On-call Physician    NP/PA   On-call NP/PA   Medical Director   Other
         Physician
                         Pre-Transfer Management

                                       Q14. Pre-Transfer Management (check all that apply)

70.00%

60.00%

50.00%

40.00%

30.00%

20.00%

10.00%

0.00%
         MD on-site   NP/PA on-site   MD/NP/PA     "Telemedicine"   IVor SQ fluids   Labs Drawn   X-ray        Med         Family/HCP   Advance Care   Other
                                      Telephonic                                                          changes/starts                  Planning
               Day of Week

Q10. Day of Week      Sat            Sun
                     11.7%          13.3%




       Fri
                                                     Mon
     18.6%
                                                    17.6%




                                             Tues
             Thurs                          12.2%
             18.1%
                             Wed
                             8.5%
 Questions

Thank you

								
To top