Crucial Complications: Preventing Harm and Promoting Health MARCI RUEDIGER, PT, MS
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?
Are trauma patients truly stable at the time they leave acute care?
What has changed over the years? Length of stay in acute care Acuity of survivors
How have we dealt with those changes and what else can we do? Huge stressors for families Level of family involvement and sophistication
What puts patients at risk?
Risks Hand-offs, care transitions Complicated medical issues Secondary complications Polypharmacy Stressed or fragmented support systems Fragmented care
How are risks addressed in rehab?
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 schoi@hcifonline.org Standardizing hand-offs
Care Transitions Focus on: Health literacy Advocacy
Complicated medical issues Consulting specialists Physicians on-site 24/7 Respiratory services 24/7 Everyone on alert
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
Secondary Complications Malnutrition Nutrition is not always top priority Hesitancy to place feeding tubes Assumptions about obese patients Importance of nutrition underestimated Blood clots
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
Still More Secondary Complications Infections Ventilator Associated Events (VAE) Catheter Associated Urinary Tract Infections (CAUTI) Injuries from falls
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
Complications of immobility Early mobility critical Specialized seating to promote recovery and prevent complications http://www.mobilization-network.org
How has the ACA (and other legislation) changed the playing field?
Incentives to avoid harm, including readmissions Penalties for acquired harm Penalties for readmissions Improved alignment of goals Collaboration can result in a winwin-win
Collaborative Work Groups A Rehab Perspective PfP - Partnership for Patients http://partnershipforpatients.cms.gov/ 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
Federal Funding for Innovative Models of Care how does rehab fit in? Medical homes Accountable care organizations
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. http://www.hsxsepa.org/
The Changing Role of the Consumer
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
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
Having Fun While Raising Awareness
THANK YOU! BELIEVE MAGEE Rehabilitation if there s a way a will Hospital back Marci Ruediger, PT, M.S. mruediger@mageerehab.org 215.587.3454