Crucial Complications: Preventing Harm and Promoting Health

Transcription

1 Crucial Complications: Preventing Harm and Promoting Health MARCI RUEDIGER, PT, MS

2 Agenda What puts patients at risk after acute care? How are these risks managed in rehab? How has the ACA changed the playing field? How does rehab fit into this new world order?

3 Are trauma patients truly stable at the time they leave acute care?

4 What has changed over the years? Length of stay in acute care Acuity of survivors

5 How have we dealt with those changes and what else can we do? Huge stressors for families Level of family involvement and sophistication

6 What puts patients at risk?

7 Risks Hand-offs, care transitions Complicated medical issues Secondary complications Polypharmacy Stressed or fragmented support systems Fragmented care

8 How are risks addressed in rehab?

9 Care Transitions Respiratory needs & Precautions At risk alerts Reaching out to acute care hospitals and other post-acute providers Emergency Transitions Advances (ETA) Susan Choi, Project Director Standardizing hand-offs

10 Care Transitions Focus on: Health literacy Advocacy

11 Complicated medical issues Consulting specialists Physicians on-site 24/7 Respiratory services 24/7 Everyone on alert

12 Poly-pharmacy Liaisons gather info before admission Reach back to acute pharmacist at admission Pharmacy involvement in care conferences Discharge planning and teaching Intensive medication reconciliation

13 Secondary Complications Malnutrition Nutrition is not always top priority Hesitancy to place feeding tubes Assumptions about obese patients Importance of nutrition underestimated Blood clots

14 More Secondary Complications Pressure ulcers Skin champs Turn me bracelets Modifying therapy for those at critical risk Specialized equipment Patient education 3 full-time WOCNs

15 Still More Secondary Complications Infections Ventilator Associated Events (VAE) Catheter Associated Urinary Tract Infections (CAUTI) Injuries from falls

16 Stressed or fragmented support systems Empower the family, friends Family conferences early in stay Discharge to structured, supportive settings where needed Post-discharge phone calls Lifetime follow-up Gaspar Center

17 Complications of immobility Early mobility critical Specialized seating to promote recovery and prevent complications

18 How has the ACA (and other legislation) changed the playing field?

19 Incentives to avoid harm, including readmissions Penalties for acquired harm Penalties for readmissions Improved alignment of goals Collaboration can result in a winwin-win

20 Collaborative Work Groups A Rehab Perspective PfP - Partnership for Patients Goals: 40% reduction in hospital acquired conditions and a 20% reduction in hospital readmissions compared to 2010, over 3-year period. HENS Healthcare Engagement Networks PA-HEN/HAP Patient and Family Engagement Advisory Council

21 Federal Funding for Innovative Models of Care how does rehab fit in? Medical homes Accountable care organizations

22 Federal Funding for Innovative Models of Care how does rehab fit in? Bundled payment plans Interconnected Electronic Medical Records HealthShare Exchange of Southeastern PA Inc.

23 The Changing Role of the Consumer

24 Consumers as vested stakeholders Asking questions about quality data Challenging care providers with questions and input Asking questions about price Consumers shop when they have skin in the game Hospitals that provide value will win. Patient/ Family Advisory Councils

25 What else could we be doing? Full length cushions in ambulances similar to those used on OR tables Standardized hand-off tools Provider to provider discharge calls on the day after the care transition Timely discharge summaries to the next provider Support the caregivers in the home, through the transitions and onward

26 Having Fun While Raising Awareness

27 THANK YOU! BELIEVE MAGEE Rehabilitation if there s a way a will Hospital back Marci Ruediger, PT, M.S. mruediger@mageerehab.org