Clinical Safety & Effectiveness Cohort # 11 I mplementation of - - PowerPoint PPT Presentation

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Clinical Safety & Effectiveness Cohort # 11 I mplementation of - - PowerPoint PPT Presentation

Dec 15, 2023 234 likes •445 views

Clinical Safety & Effectiveness Cohort # 11 I mplementation of Discharge Planning Rounds on an I npatient I nternal Medicine Service DATE Educating for Quality Improvement & Patient Safety 1 Financial Disclosure Raj Sehgal, MD has no

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Clinical Safety & Effectiveness Cohort # 11

I mplementation of Discharge Planning Rounds on an I npatient I nternal Medicine Service

DATE

Educating for Quality Improvement & Patient Safety

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Financial Disclosure

Raj Sehgal, MD has no relevant financial relationships with commercial interests to disclose.

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The Team

Raj Sehgal, MD (CS&E participant) Amjed Baghdadi, Chief of Quality Management, STVHCS Vivian Dee, Hospital Medicine Nurse Practitioner Utilization Management RNs: Kelli Alexander, Erica Barrett Mary Gaona, Marilyn Ponce, Elaine Wolff Social Workers: Angela Bodnar, Ileana Elizardo, Elizabeth Lopez, Catherine Rivera, Lynda Sandoval, Donna Stribling Sponsor Department Luci Leykum, MD, MBA, MSc

 Division Chief, Hospital Medicine, UTHSCSA

Deborah Baruch-Bienen, MD, MA Ethics, FACP

 Chief, Medicine Service, STVHCS AMD

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What We Are Trying to Accomplish?

OUR AIM STATEMENT

Increase by 5% patients meeting criteria for continued stay on internal medicine inpatient ward teams by August 2012.

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Project Milestones

  • Team Created

April 2012

  • AIM statement created

April 15, 2012

  • Weekly Team Meetings

Started May 2012

  • Background Data, Brainstorm Sessions,

Started May 2012 Workflow and Fishbone Analyses

  • Interventions Implemented

1st: May 14 2nd: June June 4

  • Data Analysis

Started July 2012

  • CS&E Presentation

September 14, 2012

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Background

  • One of the benefits of the VA system is the availability of

additional resources for many patients post-hospitalization (home health, skilled nursing facilities, hospice, etc.)

  • One of the frustrations (particularly for trainees) is navigating

this process and getting patients discharged from the acute care setting in an appropriate time frame

  • Patients in the hospital without a clear indication are at risk for

hospital-related complications (infections, deconditioning, etc.) and occupy beds needed for other acutely ill patients

  • Utilization management nurses review inpatients each day to

determine if patients continue to meet criteria for continued hospitalization

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Average: 57%

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Background

UCL 71.6% CL 56.7% LCL 41.8%

35.0% 40.0% 45.0% 50.0% 55.0% 60.0% 65.0% 70.0% 75.0% Mar-11 May-11 Jul-11 Sep-11 Nov-11 Jan-12 Mar-12 May-12

% of Patients Month

Patients Meeting Continued Stay Criteria

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Background

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Meeting Criteria Not Meeting Criteria Medical Needs, Timely Care Medical Needs, Delays in Care No Medical Needs Administrative View Clinician View

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How Will We Know That a Change is an Improvement?

  • Types of measures

– % of patients meeting criteria for continued hospitalization on the inpatient internal medicine service (using McKesson InterQual Level of Care Criteria)

  • Methods of measurement

– Summative monthly reports from Quality Management service based on daily patient reviews

  • Specific targets for change

– Original: 5% increase in the percentage of patients meeting inpatient criteria for continued stay on internal medicine ward teams from May to August 2012. – Revised: Raising percentage of patients meeting inpatient criteria to 64%

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Discharge planning process (as of April 2012)

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Plan – Do – Check - Act

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Plan – Do – Check - Act

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Plan – Do – Check - Act

UCL 71.63% 89.01% CL 56.71% 70.02% LCL 41.79% 51.02% 37% 47% 57% 67% 77% 87% 97% Mar-11 May-11 Jul-11 Sep-11 Nov-11 Jan-12 Mar-12 May-12 Jun-12 Aug-12

% of Patients Month

Patients Meeting Continued Stay Criteria (Medicine Ward Teams)

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UCL 65.57% CL 52.57% LCL 39.57% 35.00% 40.00% 45.00% 50.00% 55.00% 60.00% 65.00% 70.00% Apr-12 May-12 Jun-12 Jul-12

% of Patients Month

Patients Meeting Continued Stay Criteria - Neurology

UCL 89.84% CL 60.01% LCL 30.18% 20.00% 30.00% 40.00% 50.00% 60.00% 70.00% 80.00% 90.00% 100.00% Apr-12 May-12 Jun-12 Jul-12

% of Patients Month

Patients Meeting Continued Stay Criteria - Cardiology

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  • 1. Continue daily discharge planning rounds on the

Medicine Ward service with all VA hospitalists trained to perform PUMA (Physician Utilization Management Advisor) duties.

  • 2. Consider spreading process to other inpatient

services.

Plan – Do – Check - Act

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Return on Investment

Medicine Ward Teams % of patients meeting continued stay criteria: Previous Quarter (Q2) without intervention: 52.5% Intervention Period: 70.0% Medicine Service (including neurology, cardiology, BMT, MICU) % of patients meeting continued stay criteria: Previous Quarter (Q2) without intervention: 51.2% Intervention Period: 73.8%

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Return on Investment

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Return on Investment

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Conclusion/What’s Next

Lessons Learned

  • Relatively small investments can have major impacts on patient

care

  • Time required of attending physicians & social workers: 5 minutes, 5

days a week

  • Time required of UM nurses and Medicine Case Manager NP: 20-30

minutes daily, 5 days a week

  • Communication is key

What’s Next

  • Find ways to collect (and use) the data on processes that delay

patients’ care in the hospital.

  • Check re-admission data
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Thank you!

Educating for Quality Improvement & Patient Safety