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Bedside Patient Interviews: A Tool to Reduce Unplanned Readmissions
Bedside Patient Interviews: A Tool to Reduce Unplanned Readmissions
Bedside Patient Interviews: A Tool to Reduce Unplanned Readmissions
Bedside Patient Interviews: A Tool to Reduce Unplanned Readmissions
Bedside Patient Interviews: A Tool to Reduce Unplanned Readmissions
Bedside Patient Interviews: A Tool to Reduce Unplanned Readmissions
Bedside Patient Interviews: A Tool to Reduce Unplanned Readmissions
Bedside Patient Interviews: A Tool to Reduce Unplanned Readmissions
Bedside Patient Interviews: A Tool to Reduce Unplanned Readmissions
Bedside Patient Interviews: A Tool to Reduce Unplanned Readmissions
Bedside Patient Interviews: A Tool to Reduce Unplanned Readmissions
Bedside Patient Interviews: A Tool to Reduce Unplanned Readmissions
Bedside Patient Interviews: A Tool to Reduce Unplanned Readmissions
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Bedside Patient Interviews: A Tool to Reduce Unplanned Readmissions

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  • 1. Bedside Patient Interviews: A Tool to Reduce Unplanned Readmissions Moe Baloo, DC, MHA Margot Wilson, RN, MSN Yoly Ordovas – Patient Representative Providence Health Care February 27th, 2014
  • 2. This project is based on recommendations from a two-day IHI conference held in Victoria in March 2013 called “Reducing Avoidable Rehospitalizations”. Special thanks to the Shared Care Committee for funding and support No disclosures to declare.
  • 3. Why Study Unplanned Readmissions?
  • 4. Reducing Hospital Readmissions Unplanned hospital readmissions are prevalent, costly, and place an undue strain on patients, care providers, and the health care system1. In Canada, 2010 data show that 30-day all-cause readmission rates are 1 in 12, or 8.5%, costing an estimated 1.8 billion dollars annually, or 11% of total hospital expenditures2. 1) 2) J. R. Vest et al., “Determinants of Preventable Readmissions in the United States: A Systematic Review,” Implementation Science 5 (2010): p. 88. Canadian Institute for Health Information, All-Cause Readmission to Acute Care and Return to the Emergency Department (Ottawa, Ont.: CIHI, 2012).
  • 5. Reducing Unplanned Readmissions 3 Phases: i) Analysis of Retrospective Unplanned Readmissions Using ‘LACE’ Scores ii) Random Clinical Chart Reviews iii) One-to-one Bedside Patient Interviews
  • 6. Reducing Unplanned Readmissions – Phase I – LACE Scores Readmission Group 1: # of patients= 281 Readmission Group 1 LACE Scores 60 50 Population of interest # of patients = 163 # of patients 40 30 20 10 0 0 1 2 3 4 5 6 7 8 9 10 11 LACE SCORES 12 13 14 15 16 17 18 Analysis: Average = 10.18, Median = 10, Mode = 10 19 LACE Score 10 11 12 13 14 15 16 17 18 19 Total # of patients 50 30 38 18 9 8 2 3 2 3 163 Patient location: Vancouver - City Centre, Downtown Eastside, Midtown, North East, South, Westside Timeframe: Patients discharged between January 1, 2012 – December 31, 2012 Note: A LACE score of 10 equals a 12.2% expected probability of an unplanned readmission within 30-days of discharge. A LACE score of 15 equals a 26.6% likelihood of a readmission.
  • 7. Phase I – Key Findings 2012 readmissions data showed the following for the adult population living in Vancouver: o Congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), and gastrointestinal disorders accounted for 22% of all 30-day readmission to the acute general medicine wards at St. Paul’s and Mount Saint Joseph’s hospitals.
  • 8. Reducing Unplanned Readmissions Phase II – Chart Reviews Key Findings:  Discharge planning was occurring, but documentation regarding what materials were handed out was not consistently recorded  The electronic health record used by clinicians and administrators did not regularly ‘flag’ readmissions  No formal process for unattached patients
  • 9. Reducing Unplanned Readmissions Phase III–Bedside Patient Interviews 6 Comprehensive Interviews were conducted. 10 key questions were asked:  Do you have a family physician?  When it was time to go home, what happened?  Did you understand your follow-up plan?  Did you receive any handouts or printed information?  Did you understand what to do if you did not feel well?  Did you have a GP follow-up appointment after you left the hospital?  Did you understand all the instructions and handouts that were given to you?  What happened to make you decide to come back?  When you are discharged this time, what support would you need at home to help you remain at home to heal?  What else would you like to tell us that would improve your experience?
  • 10. Reducing Unplanned Readmissions Phase III–Bedside Patient Interviews Key Findings:  Most patients had a family physician. Access to their PCP, however, was limited.  A lack of community/home support was a key factor leading to a readmission.  Discharge instructions can be overwhelming. ‘Teach-back’ techniques may be helpful.  Attention to minor details had a positive influence on a patient’s perception of care.  Frequent turnover and changes in care provider had a negative impact on perception of care  Culture, language, and contextual factors are important.  Inpatients were generally very satisfied with the quality of care received.  Engaging the patient’s family physician and/other caregivers can help reduce the likelihood of a readmission.
  • 11. Reducing Unplanned Readmissions Phase III - Key Findings: In their own words: Staff are asked about their concerns re: patient care: Courtesy: Camille Ciarniello, PHC
  • 12. Reducing Unplanned Readmissions Phase III - Key Findings: In their own words: Patients and their families are asked about what matters most to them Courtesy: Camille Ciarniello, PHC
  • 13. Thank You. Questions?

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