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Discharge coordination of care process improvements


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This presentation outlines how 7 key metrics in discharge coordination were improved by an average of 50%.

Published in: Health & Medicine
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Discharge coordination of care process improvements

  2. 2. A Bit About Group50® Our Mission Is To Be The Only Consulting Partner Needed by Middle Market Companies • A fourteen year old consulting company that focuses on delivering industry leading business results. Our Key Practices include: • Our Service Areas are supported by experience, skills, 40+ assessments/ workshops and leading edge software tools • Headquartered in Los Angeles with over 20 consultants throughout the United States  All former operating executives from world class companies such as GE, Black & Decker, Procter & Gamble, IBM, Verizon, Accenture, AT&T, Qwest Communications, Boeing, Rockwell and others  C-Level and Board Members  Consultants who are fluent in over 10 languages  Led or participated in strategic execution projects in business, healthcare, government and NGO’s  Experienced resources in every functional area Services •Strategy and Execution •Operational Excellence •Healthcare Operations •Org Design & Development •Digital Technology •Market Effectiveness •Company Physical Industries •Manufacturing •Distribution •Healthcare •Automotive •Aerospace •Industrial Goods & Services •Consumer Products •Telecom •Non-Profit •Food Services Group50 Consulting All Rights Reserved 2017 (909) 949-9083 Slide 2
  3. 3. Value Stream: In-Patient Flow – Discharge Coordination of Care Business Case Primary: Quality Outcomes, Readmissions Secondary: Cost, Patient satisfaction, LOS Problem Statement: The current processes and systems to communicate and coordinate patient flow from ‘decision to discharge” to patient arrival at destination with all support in place (DME, home health agencies, SNF.. etc) results in less than ideal communication, coordination, patient satisfaction, family satisfaction and employee frustration Desired State: Design, Document, Implement and Deploy a process to reduce the time from “Butt in Bed” to “patient departure from unit with all support in place” by 25%. Complete support will always be in step with the scheduled discharge plans. Charter Group50 Consulting All Rights Reserved 2017 (909) 949-9083 Slide 3
  4. 4. Charter: Objectives • Establish common understanding of the current state • Identify key individuals impacting the process • Med Rec • Improve communication with patient & family to understand & come to agreement with the transition plan • Define timeline for nursing to address ‘discharge written’ patients • Case management staff notified of “d/c written” within in 30 minutes • Social Work staff coordinates referral to appropriate community agencies and confirm receipt of information • Social Work staff identifies DME/other needs for discharge • Physician will identify anticipated d/c one day in advance • Patients/Family will be notified of anticipated d/c date based on physician input Group50 Consulting All Rights Reserved 2017 (909) 949-9083 Slide 4
  5. 5. Charter: Objectives • Understand opportunities for improvement as identified by: • SNF’s • DME supplies • Home Health Agencies • Physicians • Ancillary Services • Nursing • Case Management • Care Navigators • Hospice • Palliative Care • Social Work • Private Educators • Identify process and parameters for revenue/cost risk resolution Group50 Consulting All Rights Reserved 2017 (909) 949-9083 Slide 5
  6. 6. Our Process Issues & Opportunities Admission Day On-Going Care Group50 Consulting All Rights Reserved 2017 (909) 949-9083 Slide 6
  7. 7. Our Process Pre-Discharge Day Discharge Day Post Discharge Issues & Opportunities Group50 Consulting All Rights Reserved 2017 (909) 949-9083 Slide 7
  8. 8. Understanding our Process: Wastes Admission Day BIB Ongoing Care Day of Discharge Post Discharge Care Pre-Discharge Day • Inconsistent Admission process in first 2 hrs of admission • Discharge Education starting at Admission • Consistent reinforcement from Hospitality • Understanding roles, responsibilities and timing of care utilization team • Limited and inconsistent preparation work for patient discharge • Medication Rec is inaccurate for the post discharge settings • No Rx • Lack of medication education to patient • Disruptions and delays in the discharge process Group50 Consulting All Rights Reserved 2017 (909) 949-9083 Slide 8
  9. 9. Changes and Improvements • Rounding board pilot on 5th floor for Doctors to communicate approximate round times for following day. • Initiate nurse/provider rounding sheet. • Patient Flow board • Improved admission packet. • “Plant the seed” of discharge on admission day to better prepare patient. • Noted that Pharmacy could be used in education process with medications to free up Doctor / Nurse time. • DME supplies identified earlier to allow time to fill “script”. • Triangle (Social Work, UR, Case Management) better defined and areas where they can assist. Group50 Consulting All Rights Reserved 2017 (909) 949-9083 Slide 9
  10. 10. Changes and Improvements • Possible problems with filling scripts captured to prevent readmission due to meds. • Idea of “Time Buckets” discussed to allow for better planning on discharge – used in conjunction with Rounding board. • Consulting physicians now “sign off” earlier to prevent numerous phone calls at time of discharge to get approval. • Non-brand specific Liaison for HHH and Birchaven to capture more business and assist in lowering readmission rates due to after care.
  11. 11. Changes and Improvements • Arrange transportation on day before discharge to save time on day of discharge. • Moved more discharge processes to day before discharge to be more proactive instead of reactive. • Implement new belongings sheet to assist in preventing loss. • Making follow up appointments for patients to assist with core measures. • Located key points where HA can assist nursing with processes to free up more time for nursing staff. • Noted key areas for improvement for SNF, Palliative Care, Assisted Living, etc. • Create and implement discharge planning sheet. Group50 Consulting All Rights Reserved 2017 (909) 949-9083 Slide 11
  12. 12. Changes and Improvements Patient Transportation arrangements Benefits: •Allows for coordination of the care team pre- discharge •Creates a smooth discharge process to the patient’s post discharge care Consulting physicians sign off for patient discharge pre-discharge day Discharge Day and Post Discharge Patient Needs Group50 Consulting All Rights Reserved 2017 (909) 949-9083 Slide 12
  13. 13. Patient Flow Board Projecting the expected patient discharge day according to DRG & Insurance Information The patient discharge checklist is to ensure all required discharge needs are executed before the patient is discharged Benefits • Visual communication of the patient discharge flow that is coordinated with post discharge care • Communication of a patient’s LOS that will be paid for by Medicare and all other insurance companies based on current provider documentation • Coordination of patient flow to ensure safe and efficient patient discharge Group50 Consulting All Rights Reserved 2017 (909) 949-9083 Slide 13
  14. 14. Physician Rounding Board Provider Name and Rounding Times Benefits •Allows RN to coordinate care for a 12 hour shift •Facilitates quality care from Admission to Post Discharge Care •Predicts rounding time of Physicians •Smoother flow through patient discharge Group50 Consulting All Rights Reserved 2017 (909) 949-9083 Slide 14
  15. 15. Performance Metrics Metric Baseline AFTER • 72%ile • 85%ile • 170 min • 42% 47% • 10% • 33% • 4% % CHANGE Service Excellence • Communication about Meds • Patient Discharge Info Quality • Time to Discharge Patient • Patients Discharged Prior to 2:00pm Post Discharge Care (Medicare) • Home Health • SNF • Hospice • 90%ile • 92%ile • 90 min • 80% 64% • 18% • 40% • 6% • 25% • 8.2% • 50% • 90% 36% • 80% • 21% • 50% Group50 Consulting All Rights Reserved 2017 (909) 949-9083 Slide 15
  16. 16. Leading Indicators • Number of observation patient over 23 hrs. • Patients admitted to wrong status • UR Chart review of all patients within 24 hrs. of admission • # of potential referral/# of total admissions • # of actual referrals/# of total admissions • Physician pre-discharge rounding sheet is completed • patient discharged within 2 hrs. of attending physician discharge order • All paperwork is physician ready before discharge rounding Group50 Consulting All Rights Reserved 2017 (909) 949-9083 Slide 16
  17. 17. Leading Indicators • All core measures are completed before patient discharge • # of calls to the physician on discharge day after discharge rounding • # of yellow and red boxes on patient flow board with no discharge written • # of red boxes on patient flow board with no discharge information • Admission medication list is done with 60 mins. • Referral information is all complete and no contact back to hospital Group50 Consulting All Rights Reserved 2017 (909) 949-9083 Slide 17
  18. 18. Standard Work • Patient BIB • Ongoing Care • Pre-Discharge Day • Discharge – Post Discharge Care • Social Work • Case Management • UR Group50 Consulting All Rights Reserved 2017 (909) 949-9083 Slide 18
  19. 19. Lessons Learned • Better way to discharge (whole process) • So excited about it! • Sometimes I should just shut up! • Gina is really very shy! • We are all one team • Home Health & Hospice, Pallative Care, etc, needs vital info from beginning for continued care / smooth transition. • Flow Board has more info than most staff know about. • Our current process is not effective and will take a lot of work to improve. Group50 Consulting All Rights Reserved 2017 (909) 949-9083 Slide 19
  20. 20. Lessons Learned • Fixing problems in the system is a team effort that is going to take everyone’s cooperation to be successful. • Gina is teacher’s pet. • Creating a team to solve a problem can bring great ideas and plans together. • Doctor’s don’t love frequent phone calls as we previously thought. • Learned about the Social Work / Case Mgr / UR triangle • Learned what Home Health does vs. Palliative Care • Vinnie reads lips • The flow of patient care. • Our processes are a mess and we lose a lot of $ every day due to processes Group50 Consulting All Rights Reserved 2017 (909) 949-9083 Slide 20
  21. 21. Lessons Learned • We have a lot more work to do…… • Vinnie shaves his head – not really bald!! • That we don’t have to be silos – we work well as a team. • Collaboration between Physician / RN can’t be left to chance – we need to commit to it! • Critical that discharge starts at the day of admission. • Criticality of RN / Physician rounding in coordination of Patient Care / Service Excellence. • Red is no $$ - Patient Flow Board • Empowering our unlicensed staff will help facilitate quality care Group50 Consulting All Rights Reserved 2017 (909) 949-9083 Slide 21
  22. 22. Parking Lot - Completed • Patient life style outside of BVHS? • Physician prediction of discharge – different on each floor • When do we have to notify the consulting physicians for discharge • During the patient care what technique can be use so we know if the consultation want to be contact at the patient discharge. • is it a hippa violation to share patient information before they agree to post discharge services • physician (fox) wants to have everything ready to go day before discharge • Hospitality is viewed differently on different floors • Pre- discharge checklist, foley cath, IV ATB etc…. • <50% of patient records have ”Plan to discharge tomorrow” • Day of admission set the expectation for discharge time • ambulette coordination at discharge • Best Practice of all medication education, new or old meds • “Routine” vs. CHF,PN taking meds – detail of medication list – pharmacy teaching • screen people in as candidates vs screen out • adding discharge protocol to hospitality and going over admission packet by hospitality • Add to nurses order “pharmacy consult” Group50 Consulting All Rights Reserved 2017 (909) 949-9083 Slide 22
  23. 23. Parking Lot - Open • What can we anticipate based on patient diagnosis? • Pre-authorizations from insurance companies? • hard to find the time of death for the physicians (death and dying arrangement screen) • Code 44 for next PI Event, decision to admit • Medication administration time • who is the nurse to discharge the patient and think about who is admitting them, who knows their case the best • charge capture process on the floor • ED discharge to SNF – specifically Med Rec • Computers that don’t work on the floors • directing medication prescription to outpatient pharmacy • Nurse to Patient Ratio • staffing model balance • Bridge palliative care how do we explain non branded information on HH • What is the relationship between interdisciplanary rounds and coding? • Observation unit or rooms dedicated to observation patients • Computers on the nursing floors do not function properly Group50 Consulting All Rights Reserved 2017 (909) 949-9083 Slide 23
  24. 24. Group50 Contact Information Website: email: LinkedIn: Phone: 909-949-9083 VINCENT “VINNIE” POLITO is Group50’s Healthcare Practice leader has over thirty years of experience as an executive and executive consultant in the design and delivery of Lean, Lean Transformation and operational Excellence in the Healthcare, Medical Device, Industrial Manufacturing, Aerospace, Textile and Oil and Gas industries. He has held senior management roles in operations, materials, quality, and business det. Vinnie has pioneered Lean in Healthcare. At the forefront of Lean in Healthcare since 2003 he has provided guidance to over 100 hospitals, physician/specialty practices, insurance health plans and home health systems in North America. He has a grasp and appreciates of the mission and complexity of Healthcare. He translates Lean principles and techniques into effective delivery strategies and execution specifically meeting the critical needs and culture of Healthcare. Some his more notable Healthcare clients include, Thedacare, Denver Health, Beth Israel Deaconess, Barnes Jewish, New York Health and Hospitals, and Priority Health. His Lean support of Healthcare has included initiatives for non-clinical organizations including the Institute of Medicine (IOM), the Institute for Healthcare Improvement (IHI) and National Quality Forum (NQF). Vinnie has led and executed Lean transformation in a diverse range of industries such with a client list of Fortune 500 organizations including Boeing, Alcoa, Lockheed Martin, Rockwell-Collins, Duracell, Owens-Corning, Sandia Labs and Hanes Brands. Group50 Consulting All Rights Reserved 2017 (909) 949-9083 Slide 24