Outcomes Report through June 30, 2014

Transcription

1 Outcomes Report through June 0, 0

2 Contents Introduction... Haag Pavilion (Sub-Acute Unit)... Rehabilitation Outcomes... Rehospitalization Outcomes of Sub-Acute Patients... Center for Heart Health Outcomes... Long Term Care Unit Unplanned Hospitalization Rates...6 Health Services (Nursing) Outcomes...6 Fall-related Injuries...7 House-Acquired Pressure Ulcers...7 House-Acquired/Nosocomial Infections...8 House-acquired/Nosocomial Urinary Tract Infections...9 Multi-Drug Resistant Organisms...9

3 Introduction We are pleased to present the following Outcomes Report for Lieberman Center for Health and Rehabilitation (LCHR). This report is current through the second quarter of 0 and consists of outcomes directly related to patient care. The data is specific to three areas: the Haag Pavilion (Sub-Acute Unit), Long Term Care Unit (all floors) and the Whole House (the entire facility). Haag Pavilion (Sub-Acute Unit) The Haag Pavilion offers these services with specialized staff: skilled rehabilitation therapy; a dedicated Center for Heart Health; skilled nursing, including, but not limited to, hemodialysis, peritoneal dialysis, infusion therapy, and wound care. The staff consists of the following: specially trained RNs; a full time staff nurse practitioner; physical, occupational and speech therapists; and social services staff. There are credentialed medical consultants who round weekly or see patients more often, depending upon need. The consultant medical staff consists of the following specialties: physiatry, cardiology, nephrology, infectious disease, psychiatry, neuropsychology, and wound care. Coordination of care and communication among all disciplines on the Unit is managed by the Clinical Nurse Manager, a certified rehabilitation nurse. Rehabilitation Outcomes The Therapy Department works primarily on a patient s functional status. Efforts are directed at increasing strength, endurance, and balance. The three areas that are measured are transferring/ toileting; dressing; and ambulation. Data is then used to determine a patient s overall outcomes for improvement in functional ability from their admission status to their status at the time of discharge. 7 Overall Outcomes for Rehab 0 Through nd Quarter 0 - Avg. Overall at Admit Avg. Overall at Discharge Functionality Key 7 = Independent, no assistance required 6 = Supervision, short-term, home health recommended = Stand-by assistance, personal care assistance recommended for days a week for or more hours = Contact Guard assistance, personal care recommended days a week for or more hours = Minimal assistance of -9%, 0 hours/week personal care recommended = Moderate assistance of 0-7%, 0 hours a week of personal care recommended = Maximum assistance of 7-90%, live-in assistance recommended or skilled facility 0 = Totally dependent Note: The first data point is determined by the therapist at time of the initial assessment, which is performed within hours of admission to the Haag Pavilion. The second data point is determined by the skilled therapist at time of discharge. The patient s status is measured with Functional Independence Measures (FIM) a standardized functional measurement tool with a scale of 0 to 7, where 0 = most dependent and 7 = independent (see Key, above). The average overall improved functional ability was to points on this scale.

4 Rehospitalization Outcomes of Sub-Acute Patients Below are three charts, the first two charts represent the quarterly 7-hour and the 0-day rehospitalization rates respectively. The third chart depicts the annual rates for both 7 hour and 0 day rehospitalizations. It should be noted these rates are not risk adjusted. 7 hour Rehospitalization Rates 00 through nd Quarter 0 8% 6% % % 0% 8% 6% % % 0% 7% % 9% 0% 7% 7% 6% % % % % % % % % % 0% % % st Quarter nd Quarter rd Quarter th Quarter Annual average rate % 0% % 0% % 0% % 0% % 9% 7% 0 Day Rehospitalization Rates 00 through nd Quarter 0 7% % 7% % % % % % 0% 8% % %% % 9% 7% % 6% 8% 7% st Quarter nd Quarter rd Quarter th Quarter Annual average rate Notes: The national norm for 0 day rehospitalization is 6%. The average national rate for the 0-day readmission rate for the Medicare A SNF benefit is.0% (as reported by the Illinois Quality Improvement Organization). The comparable rate for sub-acute stays for the Lieberman Center was 7% in 0 and was 0% through the second quarter of 0. %%

5 0% % 0% % 0% % 0% 6% % Annual Mean Percent for Rehospitalizations 8% 8% 7% 0% % % 0% Through nd / Quarter 0 7% 7 Hours 0 Days Center for Heart Health Outcomes In February 0 the Center for Heart Health dedicated to cardiac patients was established at the Haag pavilion. Dr. Caesar A. De Leo, a NorthShore University HealthSystem cardiologist, is the lead consulting physician for the Program. Additional training was given to the nursing department, and additional equipment was purchased. Initially patients considered for this unit had a primary cardiac diagnosis. The following statistics were aggregated for 0 and will form a baseline for outcome measurement henceforth: Total number of patients admitted with a primary cardiac diagnosis = The current average length of stay for 0 = 6 days Average age = 8 The 0 Day Rehospitalization Rate = % The 7 Hour Rehospitalization Rate = % Percent of cardiac patients discharged to home = 7% Through the second quarter of 0 the data for the Center for Heart Health are as follows: Number of admissions = 9 The average length of stay = days The average age = 8 The 0 Day Rehospitalization rate as a result of any related cardiac issues = %*** The 7 Hour Rehospitalization rate caused by any related cardiac issues = 0% Percent of cardiac patients were discharged home = 6% *** Rehospitalizaton rates are reflective of cardiac conditional causes only. About Cardiac Co-morbidities During this past year as patients were screened for statistical purposes, it was discerned that a close look at co-morbidities was required. It was observed that cardiac co-morbidities were frequently exacerbated due to the recent acute hospitalization, thus necessitating increased assessment and management. It was determined that patients with a cardiac co-morbidity should be included if the exacerbation was identified by the hospital as an active diagnosis during the hospitalization prior to the admission to LCHR.

6 Rate is per 000 Patient Days Long Term Care Unit Unplanned Hospitalization Rates Data has been collected for unplanned hospitalizations from the long term care floors of Lieberman Center. They are considered as the Long Term Care Unit for the purposes of this report. These rates are calculated per 000 patient days and are not risk adjusted. For the past two years the rate has remained between and with the average between. &.7. Unplanned LTC Hospitalizations 0 through nd Quarter Health Services (Nursing) Outcomes The data and charts that follow reflect outcomes in the following clinical areas: falls, major and minor injuries associated with falls, house-acquired pressure ulcers, house-acquired infections and urinary tract infections and the prevalence of multi-drug-resistant organisms. Falls The fall rate is calculated per 000 patient days. A stringent criterion of how falls are counted has been employed. For example, if an individual is eased to the floor, that situation is considered a fall. More in-depth investigation has identified a number of challenges associated with Lieberman s fall rates. These are: the facility s strict restraint-free policy; the age demographics of the Lieberman population 0% of the residents are between the ages of 7 to 8, and 0% are 8 years old or older; and the acute confusional delirium often associated with hospitalization and transition to a sub-acute unit. The improvement process which LCHR has implemented continues to evolve. It is primarily centered on inter-disciplinary assessment and individualized interventions. 6

7 Injury Rates per 00 Falls Rate per 000 Patient Days Annual Mean Rate for Falls 007 through nd Quarter nd Quarter House LTC Sub-Acute Fall-related Injuries The major reasons for tracking these statistics are two-fold: ) fall-related injuries are a serious health issue for the elderly population; and ) they are an indication of the effectiveness of patient-specific fall prevention interventions that reduce risk and prevent or minimize falls and fall-related injuries. Injuries are first classified as major (e.g. fracture, subdural hematoma) or minor (e.g. bruise, skin tear). It should be noted that this rate is calculated per 00 falls rather than on 000 patient days which is the methodology for all other rates calculated for Health Services (Nursing) Annual Mean Rate of Major & Minor Injury from June 006 through nd Quarter nd Quarter 0.8 Major Minor House-Acquired Pressure Ulcers Lieberman s skin management program includes protocols for prevention, treatment, and pain assessment and management. The nursing staff is augmented by a board certified podiatric surgeon and a wound specialty surgeon, who make weekly rounds and are active members of the wound management team. It is Lieberman s practice to count each pressure ulcer rather than each resident who has one or more pressure ulcers. This is a considerably more stringent method of data collection as compared to the CMS Quality Measures that report a percent of residents with pressure ulcers. 7

8 Rate per 000 Patient Days Rate per 000 Patient Days Annual Mean Rate for House Acquired Pressure Ulcers from 007 through nd Quarter 0 Note: Data is for each pressure ulcer, not each patient who acquired a pressure ulcer House LTC Sub-Acute House-Acquired/Nosocomial Infections Lieberman has used control charts for monitoring infection rates from a Whole House perspective since 007. In 007 the Sub-Acute Unit expanded to include the entire fourth floor. Surveillance activities in 007 and 008 suggested that there was an increased incidence of infection in the Sub-Acute Unit. This observation prompted the calculation and tracking of the nosocomial (house acquired) rate for the Sub-Acute Unit and the Long Term Care floors as a combined unit, as well as the Whole House. This was started in Nosocomial Infection Rate 007 through nd Quarter 0 Note Method for Aggregating Data Evolved after nd Quarter Whole House LTC Sub-Acute Unit 8

9 Rate per 000 Patient Days Rate per 000 Patient Days House-acquired/Nosocomial Urinary Tract Infections Symptomatic urinary tract infections (UTIs) are the most common infection experienced by residents of Long-Term Care facilities. Because of this, the nosocomial UTI rates are tracked for each floor. It was not until after the Sub-Acute Unit was expanded to the entire fourth floor that the UTI rate for the Long-Term Care floors was calculated as one unit. 6 0 Nosocomial UTI Rate 007 through nd Quarter 0 Note Method of Aggregating Data Evolved after nd Quarter Whole House LTC Sub-Acute Unit Multi-Drug Resistant Organisms In 007 multi-drug resistant organisms were tracked for each floor in the facility. After a full year s data was aggregated it was determined that, because the rates were so low, the methodology of using point prevalence should be changed to period prevalence (using one month as the period). This was done in 008. In 009, since the rates continued to remain very low for all of the Long Term Care floors, it was determined that it would be more informative to combine the numbers for these units. The higher prevalence rates exist in the Sub- Acute Unit with the majority present on admission Multidrug Resistant Organisms (VRE, MRSA, ESBL, C-Diff) Annual Mean of Prevalence Rates (Period used = one month) 009 through nd Quarter nd Quarter Whole House LTC Sub-acute Unit 9

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