Best of New Jersey: Readmission Reduction Successes INTERACT Quality Improvement Program Version 3.0

Transcription

1 Best of New Jersey: Readmission Reduction Successes INTERACT Quality Improvement Program Version 3.0 Loretta Kaes, BSN, RN-B-C, C-AL, LNHA, CALA Director, Quality Improvement & Clinical Services Health Care Association of New Jersey Janet Knoth, BS, RN, CHPN Quality Improvement Specialist Healthcare Quality Strategies, Inc. This material was prepared by Healthcare Quality Strategies, Inc., (HQSI), the Medicare Quality Improvement Organization for New Jersey, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. 10SOW-NJ-C /2013

2 INTERACT Webinar Series Overview and Communication Tools March 14, 2013 Advance Care Planning Tools April 11, 2013 Quality Improvement Tools June 26, 2013 Best of New Jersey: Readmission Reduction Successes August 21,

3 Housekeeping Materials at qualitynet.webex.com Submit chat questions to All Participants Phone lines have been muted Evaluation poll at the end of the presentation Webinar will be recorded and available on HQSI.org 3

4 Today s Presenters 4

5 INTERACT Quality Improvement Program: A Hospital Perspective Teresa De Peralta, MSN, ANP-BC Transitional Care Coordinator Robert Wood Johnson University Hospital- New Brunswick 5

6 Identifying Partners When RWJUH started its program how did you identify/ select/invite facilities to participate? RWJ TCP started enrolling Jan 2012 May 2012 invited area SARs to dinner meeting to Outline TCP program Set expectations of SARs Communicate what help RWJ can give to SARs Care One East Brunswick charter partner with Care Navigator Model Other preferred partners Bridgeway Care Center Aristacare Genesis 6

7 Engagement How did you engage nursing facilities with INTERACT Quality Improvement Program? Reviewed SAR QI programs to recommend Recommended Care One and Bridgeway for INTERACT National study National INTERACT training Offered to help SARs with INTERACT implementation Follow up meetings in facilities or TCP meetings 7

8 Community Collaboration 8 Current active INTERACT Partners Strategies Care One E. Brunswick Bridgeway Care Center Merwick Care Center Genesis Care Center New implementation Bridgeway Re- start/re-energize / re-focus Is it truly implemented? Provide model for evaluation Statistics Root cause analysis Workflow modification

9 Lessons Learned Barriers RWJ management Legal and risk management requirements RWJ Foundation need to stay prominent for future funding RWJ VNA Staff education focus on problem of readmission Nursing facilities Champions & early adapters Identify facility-specific project owner Effective and efficient implementation Other nursing facilities Lack of corporate QI strategy Need for education re: readmission problem 9

10 Lessons Learned Benefits What have been your lessons learned in collaborating with facilities? There will always be champions and forward thinkers A new program is best partnered with early adaptors What benefits does RWJUH receive? Reduction in readmission for targeted diagnoses Increased collaboration with area NH and PACs What benefits does RWJUH provide the nursing facilities? Subsidized care navigator model through RWJVNA NJ Health Connect 10

11 The Program What aspects of the INTERACT Quality Improvement Program are the most valuable to your hospital? Capabilities checklist Triage caremaps Do you find that your providers are utilizing interact2.net? Both Interact 2 and Interact 3 11

12 Measurements Sample preferred partner data: 2013 Re-hospitalization Rates: GOAL: 3% decline per quarter ending at 20.4% st Qtr 2nd Qtr 3rd Qtr 4th Qtr %All cause %Penalty Penalty GOAL 12

13 Analysis of 2012 and Plan for 2013 Partner 1 overall re-hospitalization rate was comparable to NJ averages, however our re-hospitalization rate for penalty diagnoses was significantly higher. In addition to following patients on our Transitional Care Program, the Care Navigator also evolved into a program development advisor. This resulted in programs such as the Walgreens Program, and a new process for Discharge Medication Reconciliation for Transitional Care Patients. This became a facility-wide model in The Care Navigator is also involved in roll-out of INTERACT 3, CHF, COPD and Palliative Care Programs, partnerships with Cardiology Groups, Staff in-services and Case Studies, NJ Relay, and EMR.

14 Measurements Sample Preferred Partner 2 data: 14

15 Measurements Sample preferred partner data: 15

16 Measurements Sample Preferred Partner 2 data: 16

17 Measurements Qualitative Increased communication and learning from regular TCP meeting attendance Improved data presentation and communication Case studies Root cause analysis skills honed Better follow up and feedback 17

18 RWJ Readmission Data - CMS 18 Metrics Medicare readmission rates for AMI Medicare readmission rates for CHF Medicare readmission rates for PNA Combined (AMI, CHF, PNA) Jan 09 Dec 11 Jan Dec12 (36 mos) (12 mos) % Reduction 23.55% 22.3% 5.3% 27.59% 24% 12.7% 23.74% 19.5% 17.9% 25.5% 22.49% 11.8% Improvement applied over prior 30 months = 107 less AMI, PNA, HF readmissions

19 RWJ Readmission Date - CMS 19 Metrics Jan 09 - Dec 11 Jan Dec 12 % Reduction All Cause Readmission to RWJ All Cause Readmission to Any Hospital 17.3% 16.5% 4.6% 22.87% 21.7% 5.1% Improvement applied over prior 30 months = 280 less readmissions

20 Contact Information Teresa De Peralta, MSN, NP-C Transitional Care Coordinator Robert Wood Johnson University Hospital Phone Numbers: Office: Cell:

21 Questions

22 The Journey of Victoria Manor in Reducing Readmissions Donna Mayer, RN, BSN Director of Nursing Victoria Manor Denise Raymond, CDP, LPN, CSW, NJCALA Senior Admissions and Marketing Director Genesis HealthCare 22

23 Decision Makers Genesis HealthCare presented a global implementation of INTERACT Quality Improvement Program to its facilities Goal: Reduce readmissions to acute care facilities 23

24 Championing Quality Improvement Directors of Nursing Root cause analysis Evaluate where change needs to take place Identify the best tools possible ( Fill your gaps with viable tools Do not duplicate existing forms 24

25 Discovering the INTERACT Quality Improvement Program INTERACT Care Paths have been a part of clinical education Root cause analysis identified reasons for transfer Goals: Catch patient changes in condition sooner Manage patients at facility If transfer needed, send the best report possible 25

26 INTERACT Tools and Staff Education Care Paths Clinical staff Stop and Watch Support staff SBAR Clinical staff Nursing Capabilities list Physician, nurse practitioner, and clinical staff 26

27 INTERACT Tools and Goals Care Paths Consistent clinical protocol Stop and Watch Engage additional staff members SBAR Consistent reporting Track patient condition changes Nursing Home Capabilities List Provide to the hospital ED and primary care physicians Every transfer is not an admission 27

28 Barriers and Successes Barriers Corporate initiatives are sometimes challenged Culture-change Time consuming (initial concern of nurses) Successes New unit managers quickly adapted to new system Improved communication increased ED awareness of Nursing Facilities Capabilities list SBAR improved staff confidence when giving report 28

29 Embedding INTERACT at Victoria Manor Stop and Watch Used by therapy and aides Left on medication cart; decreases interruption during medication pass Passed on to unit manager; actively trends patient SBAR Left in MARS for consistent review and update Report at shift change 29

30 Embedding INTERACT at Victoria Manor continued Nursing Capabilities List Face-to-face meeting with two hospital ED liaisons Include Nursing Capabilities Flyer in transfer envelope INTERACT Transfer Envelope EMT staff expectation of envelope value during transfer Improved relationship with ED staff 30

31 Continuous Quality Improvement Quality Improvement Review Ongoing clinical review of all hospital readmissions Using root cause analysis Including staff involved with transfer Quality Assurance Meetings Quarterly readmission report Ongoing staff input about implementation process of INTERACT Quality Improvement Tools 31

32 Contact Information Donna Mayer, RN Director of Nursing Victoria Manor (609) Denise Raymond, CDP, LPN, CSW, NJCALA Senior Admissions and Marketing Director Genesis Healthcare (609)

33 Polling Question #1 What barriers do you need to remove? Leadership/staff buy-in Lack of physician collaboration and cooperation Families want residents hospitalized Your facility already has similar forms and processes 33

34 Let s Discuss the INTERACT Quality Improvement Program in Assisted Living Communities Interviewer: Loretta Kaes BSN, RN-B-C, C-AL, LNHA, CALA Director, Quality Improvement & Clinical Services Health Care Association of New Jersey Interviewee: Elaine Jeffers RN, LNC, CCM, CDP, C-AL Regional Director of Health Services Chairperson of NJ Assisted Living Nurses Association Chelsea Senior Living 34

35 Discovering INTERACT The assisted living INTERACT Quality Improvement Program is still in the pilot stage. How did you find out about the INTERACT Quality Improvement Program? Who would make the decision to implement INTERACT? 35

36 Implementation Do you think champions/ co-champions would be effective in your setting? How would you implement INTERACT? Would it be by area or system wide? 36

37 The Tools Which INTERACT tools would you use and why? Stop and Watch SBAR Capabilities List Other Have you found interact2.net useful, such as resident education handouts and/or guidance for having end-of-life conversations? 37

38 Advance Care Planning Will you consider using the INTERACT Quality Improvement Program tools to increase awareness of advance care planning? Has your facility incorporated the POLST form in patient education? 38

39 Barriers and Successes Often assisted living communities follow the mantra, When in doubt send them out. What challenges do you anticipate in changing the culture in order to improve transfers and reduce readmissions? 39

40 Measurement Are you measuring resident transfers and readmissions? Have root cause analyses of readmissions been effective for identifying areas that may need reassessment? 40

41 Assisted Living Capabilities Considering that the goal is to keep residents out of the hospital and improve communication between healthcare providers: What services would you include on the assisted living capabilities list? (i.e., stat blood work, Doppler studies, UTI treatment, etc.?) 41

42 INTERACT Quality Improvement Program How do you anticipate that using the INTERACT Quality Program will increase resident satisfaction and quality of life? 42

43 Contact Information Loretta Kaes BSN, RN-B-C, C-AL, LNHA, CALA Director of Quality Improvement & Clinical Services Health Care Association of New Jersey (609) Elaine Jeffers RN, LNC, CCM, CDP, C-AL Regional Director of Health Services Chairperson of NJ Assisted Living Nurses Association Chelsea Senior Living (908)

44 Polling Question #2 What do you see as the biggest value in the INTERACT Quality Improvement Program? Developing a shared vision within your facility Focusing on continuous quality improvement Streamlining work processes and avoiding redundancies Developing cross-continuum partnerships 44

45 Implementing the INTERACT Quality Improvement Program Karen Gentile, RN Director of Nursing/Assistant Administrator Inglemoor Rehabilitation and Care Center 45

46 The Decision Makers Nursing administration was supported by management Looking to be the leader in reducing readmissions from our long-term care/sub-acute facility back to hospital 46

47 Champions 1 nurse and 1 CNA from each of the 4 units (we had to work with staff on changing the culture) 47

48 Discovering INTERACT INTERACT was the buzzword for everyone in the long-term care/sub-acute industry Researched online ( and the information was easy to use Training session at Health Care Association of New Jersey (HCANJ) 48

49 Implementation Implemented with the nurses on all 4 units to emphasize: Early identification through frequent assessments/ reassessments using the INTERACT Care Paths Evaluating, documenting, and communicating changes (with SBAR) in patients assessment Rolled out the Stop and Watch with aides, dietary, and housekeeping staff

50 The Tools Stop and Watch SBAR Nursing Home Capabilities List Interact2.net Struggled a little because the CNAs were not completing the form, although they were communicating the information Utilizing the SBAR for over 8 months. It has increased communication and nurses credibility Use of SBAR allows nurses to capture and communicate critical information Share capability list with hospitals to update them on services offered A wealth of information and resources to help roll out the program

51 Advance Care Planning POLST education for patients is the focus for our social workers, physicians, and nurses

52 Barriers and Successes Barriers Biggest barrier is CHANGE; staff education is ongoing Nurses had to realize that they were capable of caring for more acute patient conditions Mindset had to be changed: sending a patient out to the emergency room is better Successes Staff is better trained to handle more acute patients Patient changes assessed more consistently Increased communication across the board Decreased readmissions Better patient outcomes

53 Measurements Tracking transfers (planned/unplanned) and acute care readmissions Continuing to see a decrease in readmissions, as well as improving patient outcomes Conducting root cause analysis helps nurses to see a transfer through fresh eyes, such as: Assessment was not as complete as it could have been Information could have been better communicated Covering physician was not fully informed and chose to inappropriately send a patient to the emergency room

54 Success/Patient Story Prior to INTERACT implementation, cardiac patients (with diagnosis of CHF, COPD) would bounce back and forth between the hospital and our facility Empowered staff (with physician support) to better assess and recognize changes INTERACT Care Paths and Acute Change in Condition File Cards have significantly reduced the number of patients readmitted to the hospital Symptom management has improved our patients satisfaction

55 Contact Information Karen Gentile, RN Director of Nursing/Assistant Administrator Inglemoor Rehabilitation and Care Center (973) , ext

56 Questions?

57 Contact us Loretta J. Kaes, BSN, RN-B-C, C-AL, LNHA, CALA Director, Quality Improvement & Clinical Services Health Care Association of New Jersey (609) Janet Knoth, BS, RN, CHPN Quality Improvement Specialist Healthcare Quality Strategies, Inc. (732) , ext