10/24/ th Annual Nursing Research Conference Presented By: Heather Powell & Jeanmarie Okoniewski

Transcription

1 9 th Annual Nursing Research Conference Presented By: Heather Powell & Jeanmarie Okoniewski Heather J. Powell, MSN, RN, RN-BC Kimberly D. Williams, MPH Jeanmarie Okoniewski, MSN, RN, RN-BC Melinda Acevedo, MSN, RN, RN-BC Jen Toto, BSN, RN-BC Aimee Vincent, MSW John McMillen, MBA, MS, BSN, RN, NE-BC 5C Nursing Staff Value Institute at Christiana Care 1

2 Preventable readmissions are consistently cited as a source of healthcare system inefficiency and directly result in poor patient outcomes Multi-disciplinary team of physicians, nurses, social workers, case managers, unit clerks, patient care facilitators, and community colleagues redesigned the transition process for inpatient discharges to communitybased extended care facilities (ECFs) Objective: To improve patient transitions from the hospital setting to ECFs through a streamlined discharge process and measure the impact on hospital readmission rates. Identified Gaps: Poor hand-over communication Quality of key documentation Timeliness of the discharge Lack of collaborative follow-up Hypothesis: Addressing deficiencies in the hospital discharge process will improve hospital-ecf communication during patient transitions and reduce readmissions from ECFs. Post-acute care patients being discharged from regional independent academic medical center unit to communitybased ECFs Sub-set included congestive heart failure (CHF) / chronic obstructive pulmonary disease (COPD) patients 2

3 Creation of disease specific communication tools Develop a new discharge packet to streamline documentation received by ECF Primary outcome: Seven-day readmission rates for allcause patients Secondary outcome: Seven-day readmission rates for CHF/COPD patients Notification that ECF bed was available Discharge order was written Physician Interagency orders completed Physician Medication Reconciliation completed Discharge summary was dictated All information was faxed to ECF Nurses called report earlier in the day Nursing communication sheet was completed Transportation was arranged by social work Nursing clinical summary This was selected based on patients diagnosis Nursing interagency communication form Physician interagency order forms Physician medication reconciliation Discharge Summary 3

4 % Readmissions baseline 10/24/2014 CHF 20% 18% 16% 14% 12% 10% 8% 6% 4% 2% 0% 10.4% FY10 (N=328) 7.4% FY11 (N=326) 6.1% FY12 (N=261) 6.7% 6.3% FY13 (N=357) FY14 (N=288) Discharge Year Chi-square df p-value FY FY FY FY Total

5 % Readmissions baseline 10/24/ % 18% 16% 14% 12% 10% 8% 6% 4% 2% 0% 17.6% FY10 (N=153) 5.6% FY11 (N=161) 7.2% FY12 (N=125) 9.4% FY13 (N=159) 8.1% FY14 (N=123) Discharge Year Chi-square df p-value FY FY FY FY Total The redesigned transition process resulted in sustained reductions of annual readmission rates from baseline Reduction in readmission rates was also maintained from baseline for CHF / COPD patients While post-implementation readmissions remain below baseline rate, annual readmission rates for overall study unit and CHF / COPD patients reflected slight upward trend 5

6 Response Count Response Count 10/24/2014 Patient transfers from hospitals to ECFs represent a pivotal period in the continuum of care Improving communication has the capacity to effectively reduce inpatient readmission rates Streamlining the transition process positively impacts patient care overall Strongly Agree Agree Neutral Disagree Strongly Disagree 0 August 2011 (N=10) November 2011 (N=15) Strongly Agree Agree Neutral Disagree Strongly Disagree 0 August 2011 (N=11) November 2011 (N=15) 6

7 Medical record received Discharge summary recevied Able to process Rx rapidly Timely nurse report Aug-11 (N=12) Nov-11 (N=15) SNF attending contacted by Hospital attending 0% 20% 40% 60% 80% 100% % Response (Yes) Herndon, L., Bones, C., Bradke, P., & Rutherford, P. (2013). How-to Guide: Improving Transitions from the Hospital to Skilled Nursing Facilities to Reduce Avoidable Rehospitalizations. Cambridge, MA: Institute for Healthcare Improvement. Retrieved from The Joint Commission. (2001). Core Measure Sets, Heart Failure. Oakbrook Terrace, IL: Joint Commission Resources. Retrieved from Joynt, K. & Jha, A. (2012). Thirty-Day Readmissions- Truth and Consequences. The New England Journal of Medicine, 366(15), Jocobs, B. (2011). Reducing Heart Failure Hospital Readmissions From Skilled Nursing Facilities. Professional Case Management, 16(1), Nelson, J. M. & Carrington, J. M. (2011). Transitioning the older adult in the ambulatory care setting. AORN Journal, 94(4),