Collaborative tools in healthcare

Improving Post Discharge care
Dr. Sawad Thotathil| Vice President, Performance Improvement
New England Inpatient Specialists
North Andover MA

The problem scenario when the project was initiated


Winchester hospital was trying to ensure post discharge follow up. This involved a floor
RN calling up the practice



Problems faced

 Time away from bedside. Each call could take 10 to 15 minutes
 Practice staff could not immediately give appointments as they have to check with the

providers.
 Closing the loop through back and forth calls was not practical

Project Scope


Goal : Improve post discharge patient care by ensuring discharged patient follow up at
the PCP office



Objective: Establish simple Facebook-Page-type asynchronous communication
between hospitalist team and PCP offices to enable closed loop hand-off
communication on discharges and appointments (of Hospitalist patients).

Project metrics


This project involves ALL Patients having a designated PCP from one of the 6
practices and are cared for by the NEIS hospitalist team at Winchester Hospital



Performance metrics looked at in this project

 Of all patients, % of patients which were followed up by the PCP team soon after

discharge; follow up is defined as a staff member from the practice acknowledges some
action has been taken such as “informed MD”, “talked to patient”, “appointment given on
date xxx”, “patient seen” etc.
 Of all patients, % of patients given an appointment date
 Average number of days between discharge date and appointment date

Project course


Initiated Aug 2012



Practices enter the project over the next few months



Setting up involved –Obtaining agreement of the Practice leader, 1 or 2 sessions of
training for practice staff (1 or 2 at each practice either RN ,medical assistant or NP)



Within a couple of months of setting up, this has moved from being a project to
becoming the routine system of communication to fulfill the objectives

Why asynchronous group communication is better
for Care coordination?


Care coordination needs coordination between organizations as diverse as senior
services to specialist offices



Delays ,bottlenecks and lack of care (at the right time at the right moment) are mostly
due to the inability to coordinate the decision making and actions of the different
stakeholders.



The operating currency is Information



Depending on One-to-one communication to pass critical information between
multiple stakeholders does not succeed because



This channel is only as strong as the weakest link in the chain

 Different stakeholders work in different ‘time zones’ resulting in failure to connect

Benefits of Asynchronous communication


The problem of the weakest link is overcome by using Broadcasting methods in which
if one person is unable or does not pick up and act on a piece of information, another
concerned person will pick up on it



If people with different workflows and time conveniences need to connect
consistently, they need to be able to leave an information packet to be picked up at
the convenience of the other i.e. communicate asynchronously



Behavioral routines of Closing the loop on a request serve to reinforce communication
links between persons/teams

Transactional collaboration
Broadcasting from team to team

Practice - BUR
Total Patients Discharged to Practice = 312
120%

Practice - BUR
Total Patients with Appt Made = 209
10
9

100%

8
7

80%

6
60%

Percentage Appt Made
Percentage Followed Up

40%

5
Average # of Days Between
D/C & Appt

4
3
2

20%

1
0%

Quarter Quarter Quarter Quarter Quarter Quarter
3 2012 4 2012 1 2013 2 2013 3 2013 4 2013

3 2012 4 2012 1 2013 2 2013 3 2013 4 2013

Practice = MARK
120%

Practice = MARK
16
14

100%
12
80%
10
60%


8
D/C & Appt

6

40%
4

20%
2
0%

0
Quarter 4 Quarter 1 Quarter 2 Quarter 3 Quarter 4
2012
2013
2013
2013
2013

2012
2013
2013
2013
2013

Practice - TEWK
120%

Practice - TEWK
9
8

100%
7
80%

6
5

60%


D/C & Appt

4

40%

3
2

20%
1
0%

3 2012 4 2012 1 2013 2 2013 3 2013 4 2013

3 2012 4 2012 1 2013 2 2013 3 2013 4 2013

Practice - WFP
100%

Practice - WFP
14

90%

12
80%
10

70%
60%

8

50%


40%


30%

D/C & Appt

6

4

20%
2
10%
0%

2012
2013
2013
2013
2013

2012
2013
2013
2013
2013

Practice - WMW

Practice - WMW

120%

60

100%

50

80%

40

60%


30
D/C & Appt

40%

20

20%

10

0%

2012
2013
2013
2013
2013

2012
2013
2013
2013
2013

Practice - WMWo
120%

Practice - WMWo
18
16

100%
14
80%

12
10

60%


D/C & Appt

8

40%

6
4

20%
2
0%

2012
2013
2013
2013
2013

2012
2013
2013
2013
2013

What technology was used?


Salesforce.com platform



This platform has a collaborative tool called Chatter that you saw in the screenshot



Beyond this project, we have gone on to use Chatter for our group’s Nursing home
providers (for internal use at this point)



It is possible to use the same platform for virtual care teams focused on individual
patients and even get patients communicating

Thank you
sawad@neinsp.com
7815308634

Collaborative tools in healthcare

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