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USING PATIENT NAVIGATION IN AN
ORTHOPEDIC SERVICE LINE TO DRIVE
OUTCOMES AND PATIENT
SATISFACTION
Kate Gillespie MBA, RN, ...
Speakers
Kate Gillespie MBA RN NE-BC
Kgillespie@virtua.org
Assitant Vice President- Orthopedic Service Line
Virtua Health,...
Objectives
 Identify key elements needed to implement a nurse
navigation program
 Discuss what is needed to grow and sus...
BACKGROUND
Kate Gillespie MBA, RN, NE-BC
Virtua Health System, Southern New Jersey
Joint Replacement Institute
JRI occupying the entire
4th
floor (53,000sqft),
Nurse Navigation as a Foundation of the Care
Path
 Directs Patient Flow:
 Pre-op screening process
 Discharge plan
 On...
Our Journey: Nurse Navigation
 Traditional model
 Pilot started in 2010, navigated our 2nd
highest
volume joint replacem...
DEVELOPING THE NAVIGATION
PROCESS
Jennifer Smith MSN RN ACNS-BC CPHQ
Nurse Navigator Job Description
Job Description
Title: Clinical Navigator Job Code: 1624
Department: Access Center Locatio...
Developing the Process
 Voice of our customer- Patient, Office, PAT, Case
Management
 Roles and responsibilities- Cleara...
Navigation Pathway
 Administrative Assist schedules Navigation call, blackout
dates, electronic Care Path
 Initial Nurse...
Obtaining DME Pre-op for Medicare Patients
 DME Company must have won the Medicare
competitive bid
 Virtua works with 2 ...
1 week from surgery
Navigator calls
patient to prep
for H&P and
Surgery
Total Joint Navigation Timeline
Patient
decides to...
Growth Leads to Change
 Re-evaluation of Program
 Duplication of Services: medical history, too many
touch points
 Tech...
Results
 Satisfaction:
 99th
% HCAHPS
 Surgical Cancellation Rate:
 Less than 1%
 Navigator assists with back fill
 ...
FUTURE STATE
Kate Gillespie MBA, RN, NE-BC
The Future of Navigation
 CMS BPCI Bundle Payment: post acute follow-up
 Addition of Bariatric and Spine Surgery
 New E...
We welcome your
Questions
Using Patient Navigation in an Orthopedic Service Line to Drive Outcomes and Patient Satisfaction
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Preparing for joint replacement surgery can be overwhelming for many patients; they often feel inundated with the number of tasks that need to be completed prior to surgery such as medical appointments, preadmission testing, and preparing for their recovery. Learn how one health system used technology and nurse navigation to guide their patients through the joint replacement journey.
About the Speakers:
KateG100Kate Gillespie is the AVP of the Orthopedic Service Line at Virtua in Southern New Jersey. Kate received her BSN from the College of New Jersey and her MBA in Health Care Administration from Eastern University, she is certified in Nursing Administration. As the Orthopedic service line leader her responsibilities include driving efficiency through standardization, cost containment and quality outcomes. Kate is a certified Six Sigma Black Belt with expertise in operation efficiency and lean methodology. As a Six Sigma Black Belt, Kate has led quality and financial projects, and co-led multiple Kaizen projects. She is also active in New Jersey State Nurse Association and chairwoman for the NJ INPAC.
J Smith100Jennifer Smith is the Director of Clinical Outcomes for the Orthopedic Service at Virtua in Southern NJ. Jennifer received her BSN from Thomas Jefferson University and her MSN in Nursing from Villanova University. As the Director of Clinical Outcomes her responsibilities include driving standardization and quality outcomes for the service line. Jennifer is certified as both a Clinical Nurse Specialist in Adult health and Professional in Health Care Quality.

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Using Patient Navigation in an Orthopedic Service Line to Drive Outcomes and Patient Satisfaction

  1. 1. USING PATIENT NAVIGATION IN AN ORTHOPEDIC SERVICE LINE TO DRIVE OUTCOMES AND PATIENT SATISFACTION Kate Gillespie MBA, RN, NE-BC Jennifer Smith MSN, RN, ACNS-BC, CPHQ
  2. 2. Speakers Kate Gillespie MBA RN NE-BC Kgillespie@virtua.org Assitant Vice President- Orthopedic Service Line Virtua Health, Marlton NJ Jennifer Smith MSN RN ACNS-BC CPHQ JLSmith@virtua.org Director of Clinical Outcomes- Orthopedic Service Line Virtua Health, Marlton NJ
  3. 3. Objectives  Identify key elements needed to implement a nurse navigation program  Discuss what is needed to grow and sustain a navigation program
  4. 4. BACKGROUND Kate Gillespie MBA, RN, NE-BC
  5. 5. Virtua Health System, Southern New Jersey
  6. 6. Joint Replacement Institute JRI occupying the entire 4th floor (53,000sqft),
  7. 7. Nurse Navigation as a Foundation of the Care Path  Directs Patient Flow:  Pre-op screening process  Discharge plan  One message to the patient  Manages the Patient Experience:  Coordination of Services  Informs patient of expected time line  Helps patient develop their plan of care 2014 The Advisory Board Company: Interviews & Analysis
  8. 8. Our Journey: Nurse Navigation  Traditional model  Pilot started in 2010, navigated our 2nd highest volume joint replacement surgeon  Navigators role and responsibilities vs surgeon’s office staff vs pre-admission testing  Navigator patient volume
  9. 9. DEVELOPING THE NAVIGATION PROCESS Jennifer Smith MSN RN ACNS-BC CPHQ
  10. 10. Nurse Navigator Job Description Job Description Title: Clinical Navigator Job Code: 1624 Department: Access Center Location: IS Marlton ************************************************************************************ Job Summary: Facilitates all necessary care from the decision to have a joint replacement through the final post operative visit. Serves as a single point of contact for physicians, patients and caregivers to provide resources and assistance with accessing clinical and supportive care services offered within Virtua and in the community. Job Responsibilities: EF designates whether the responsibility is an “Essential Function” or not. See back page for details. % Time EF* (Y/N) Position Responsibilities 30 Y Assist patients in understanding their choice to have a total joint replacement, what to expect from the surgery, how to prepare. Serves as an essential link between patients and all other care providers. This includes scheduling PATs, all necessary clearances, patient education classes and other support services. 30 Y Follows patients throughout the care continuum, including pre operative appointments, inpatient admissions, home care, and outpatient physical therapy. 25 Y Reduces the risk for canceled surgical cases by ensuring the timing of all necessary clearances and PATs. Helps patients understand their insurance coverage as well as the necessary durable medical equipment required for recovery. 5 Y Develops concise patient itinerary for use by the patient and the care team, and documents all communication with the patient. 5 Y Develops, plans and presents patient education programs and tools 5 Y Responsible for outreach efforts to establish and maintain positive working relationships with key customers (physicians, office staff, diagnostic staff, nurses, social services staff, etc.) 100% Position Qualifications Required: Required Experience: Experienced RN with at least five years of patient and clinical experience. Joint experience a plus. Proven track record of patient satisfaction and customer focus. Ability to interact with all levels. Must be proficient in computers and databases, and comfortable with new technology. Must have superior interpersonal skills and he ability to multi-task in this fast- paced customer service environment. Team player. Required Education: Registered Nurse Training / Certification / Licensure: Active NJ Licensed RN and BSN
  11. 11. Developing the Process  Voice of our customer- Patient, Office, PAT, Case Management  Roles and responsibilities- Clearances, Insurance Authorization, DME Equipment  Shadowing: Surgeon, PA, Office, OR, Hospital  Developing protocols and standing orders: PAT, MRSA, Post- op Management  Onboarding new patients: Communication to Navigator of new patient
  12. 12. Navigation Pathway  Administrative Assist schedules Navigation call, blackout dates, electronic Care Path  Initial Nurse Navigation phone call:  Medical History, Med Reconciliation, Scheduling of medical clearances, PAT, CT Scans, Education- Wellbe Care Path, Pre- Op Class  Assist with obtaining DME equipment  Guidance throughout the pre and post-op period  Assists with rehab placement
  13. 13. Obtaining DME Pre-op for Medicare Patients  DME Company must have won the Medicare competitive bid  Virtua works with 2 companies that services- 4 surrounding states  Pre-op DME script must contain:  ICD-10 Diagnosis & Procedure Codes
  14. 14. 1 week from surgery Navigator calls patient to prep for H&P and Surgery Total Joint Navigation Timeline Patient decides to have surgery 24 to 48 hrs Office sends intake form to navigators Navigator contacts patient * If > 10 to 12 wks out make appointment to call in 10 to 12 wks Patient has surgery Patient H&P Visit with PA Patient PAT Visit 48 to 72hrs Navigator calls patient 2 weeks from surgery 3 weeks from surgery 4 weeks from surgery Office All patient info to PAT PAT All charts and patient info to surgical area PAT All patient info to Anesthesia Patient has surgery Night before surgery 1.5 weeks from surgery Patient PCP Clearance 10 to 12 weeks from surgery
  15. 15. Growth Leads to Change  Re-evaluation of Program  Duplication of Services: medical history, too many touch points  Technology Access: Physician EMR, EMR limitations  Appropriate Patient volume per Navigator  Current EMRs & Wellbe
  16. 16. Results  Satisfaction:  99th % HCAHPS  Surgical Cancellation Rate:  Less than 1%  Navigator assists with back fill  30 Day Readmission Rate:  2.5%  LOS:  1.3 days  Discharge to Home:  90%
  17. 17. FUTURE STATE Kate Gillespie MBA, RN, NE-BC
  18. 18. The Future of Navigation  CMS BPCI Bundle Payment: post acute follow-up  Addition of Bariatric and Spine Surgery  New EMR Integration
  19. 19. We welcome your Questions

Preparing for joint replacement surgery can be overwhelming for many patients; they often feel inundated with the number of tasks that need to be completed prior to surgery such as medical appointments, preadmission testing, and preparing for their recovery. Learn how one health system used technology and nurse navigation to guide their patients through the joint replacement journey. About the Speakers: KateG100Kate Gillespie is the AVP of the Orthopedic Service Line at Virtua in Southern New Jersey. Kate received her BSN from the College of New Jersey and her MBA in Health Care Administration from Eastern University, she is certified in Nursing Administration. As the Orthopedic service line leader her responsibilities include driving efficiency through standardization, cost containment and quality outcomes. Kate is a certified Six Sigma Black Belt with expertise in operation efficiency and lean methodology. As a Six Sigma Black Belt, Kate has led quality and financial projects, and co-led multiple Kaizen projects. She is also active in New Jersey State Nurse Association and chairwoman for the NJ INPAC. J Smith100Jennifer Smith is the Director of Clinical Outcomes for the Orthopedic Service at Virtua in Southern NJ. Jennifer received her BSN from Thomas Jefferson University and her MSN in Nursing from Villanova University. As the Director of Clinical Outcomes her responsibilities include driving standardization and quality outcomes for the service line. Jennifer is certified as both a Clinical Nurse Specialist in Adult health and Professional in Health Care Quality.

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