Innovation in Care Delivery: The Patient Journey

Jeanette Ives Erickson, RN, DNP, FAANSenior Vice President for Patient Care and Chief NurseMassachusetts General HospitalBoston, MA

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Objectives

At the completion of this workshop participants will:

1. Illustrate the impact that innovation units have in making care delivery safe, effective, efficient, timely, equitable and patient- and family-centered.

2. Describe the role of the attending nurse in promoting continuity of care.

3. Identify strategies to promote patient and family involvement in the plan of care.

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Waste in the US Healthcare System: A Story Emerges

JAMA 2012;307:1513-6

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Rising health care costs are a problem

• Per capita health care costs have grown steadily for 40 years

• Unmet need is perpetual

• Expanding health insurance coverage magnifies cost pressures

• The US employer-based health insurance system is a handicap in a global economy

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Per Capita Growth In Health Expenditures Has Increased at 2%

Above Inflation For 40 Years

Source: 2009 presentation by Stuart Altman, PhD titled Growing Healthcare Spending: Can or Should It Be Controlled to Prevent a Health System “Meltdown” ?

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Here’s What Is Happening in Health Care in the US

Michael Porter, Harvard Business School 2011

Here’s Where We Need to Go

Michael Porter, Harvard Business School, 2011

A need to innovate

new ways of being

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Positioning MGH for The Future

Technology Application: Partners E-Care, Outcomes Registries

ThePatientJourney

Direct Patient Care:

ED, Periop, Inpatient

(Innovation Units)

Population Manageme

nt:Reducing the

Trend of Healthcare

Costs, Long-term

Outpatient Care

Patient Affordability For MGH & Payers:

Overhead (Non-Labor

costs)

Care Redesign: Multidisciplina

ry Services, Large Patient

Population, Big $$$

Incentives: Intrinsic and Extrinsic

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Innovating Care at MGH

Innovation Units are tests of change that will help us quickly identify what works and what does not work to improve the quality of care delivered to our patients.

High performing interdisciplinary teams that deliver safe, effective, efficient, timely, equitable care, that is patient- and family-centered

Standardization of processes and care reduces variation and introduces a systematic approach to improving quality and safety in the inpatient setting

Identify and prioritize hazards and opportunities for standardization, then implement evidence based methods to rectify the problem

We are attempting transformational change.We are attempting transformational change.

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Care delivery should always be: patient and family-focused, evidence-based, accountable and autonomous, coordinated and continuous.

It’s important to know the patient.

Inpatient and family care is provided by a designated nurse and physician who are accountable and responsible for continuity of care.

Continuity of the team is a basic precept.

Every novice team member deserves mentoring from an experienced clinician.

Every patient deserves the opportunity to participate in the planning of his/her care.

Advancements in technology create opportunity for improved provider communication and efficiency.

Care should be delivered in the most cost-effective manner.

Guiding Principles

Revised 2013Revised 2013

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Before During Post

Where Are There Opportunities to Reduce Costs Across These Processes of Care?

Admission Process: ED,

Direct Admits,

Transfers

Patient Stay; Direct Patient Care, Tests, Treatments, Procedures,

Clinical Support, Operational Support

Discharge Process

Post Discharge Care

Preadmission Care

Support Functions: Finance, Information Systems, HR

Goal: High-performing interdisciplinary teams that deliver safe, effective, timely, efficient and equitable care that is patient and family centered.

“Patient Journey” Framework

Copyright Partners HealthCare 2011Copyright Partners HealthCare 2011

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Before During After

Admission process: ED, direct admits,

transfers

Patient stay; direct patient care; tests; treatments; procedures;

clinical support; operational support

Discharge process

Post-discharge

care

Pre-admission

care

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Innovations in Care Delivery “Patient Journey” Framework – Initial 15 Interventions

Relationship-based care ♦ The Attending Nurse role ♦ Hand-Over Rounding Checklist

Discharge Planning: -Est. discharge date -Discharge disposition

Welcome Packet (notebook and discharge envelope)

Domains of PracticeDaily Interdisciplinary Team RoundsElectronic Unit WhiteboardsIn-Room WhiteboardsSmart Phones Wireless laptop computers/tabletsBusiness cards Hourly roundingQuiet hours

Discharge -Follow-up Call Program

Goal: High-performing, inter-disciplinary teams that deliver safe, effective, timely, efficient, and equitable care that is patient- and family-centered

Copyright MGH 2012Copyright MGH 2012

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Three Key Areas of Focus and Four Desired Outcomes

Focus1. New Culture through Relationship-Based Care

2. New Role of Attending Nurse; Domains of Practice

3. Standardized Processes Throughput and LOS Reduction Technology Controlling Variation Implementing Evidence-Based Practice

Outcomes1. Patient Satisfaction: care is equitable and patient- and family-focused

2. Clinical Quality: to improve quality and to make care safer

3. Unit Cost Reductions: to make care more cost effective

4. Staff Satisfaction: to remain a great place to practice

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Roll-Out of Innovation Units

• Wave I: 12 Units launched March 10, 2012

Unit Types: General Surgery; Vascular Surgery; General Medicine; Orthopaedics; Oncology; Newborn/Family; Pediatrics; Psychiatry; Neonatal ICU; Cardiac ICU; Surgical ICU

• Wave II: 27 Units launched April 1, 2013

Unit Types: General Medicine; Medical ICU; Cardiac Surgery (ICU and Intermediate); Cardiac Telemetry and Intervention; Orthopaedics; General Surgery; Thoracic Surgery; Gynecology; Oncology; Newborn/Family; Pediatrics; Burns/Plastics; Transplant; Neuroscience (ICU and General); Respiratory Acute Care

• Wave III: 4 Units launched September 24, 2013

Unit Types: General Medicine; Surgical ICU; Short-Stay Unit; Observation Unit

• Wave I: 12 Units launched March 10, 2012

Unit Types: General Surgery; Vascular Surgery; General Medicine; Orthopaedics; Oncology; Newborn/Family; Pediatrics; Psychiatry; Neonatal ICU; Cardiac ICU; Surgical ICU

• Wave II: 27 Units launched April 1, 2013

Unit Types: General Medicine; Medical ICU; Cardiac Surgery (ICU and Intermediate); Cardiac Telemetry and Intervention; Orthopaedics; General Surgery; Thoracic Surgery; Gynecology; Oncology; Newborn/Family; Pediatrics; Burns/Plastics; Transplant; Neuroscience (ICU and General); Respiratory Acute Care

• Wave III: 4 Units launched September 24, 2013

Unit Types: General Medicine; Surgical ICU; Short-Stay Unit; Observation Unit

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Relationship-Based Care improves outcomes:

Enhanced Quality Improved Clinical Safety Increased Patient and

Family Satisfaction Increased Physician and

Staff Satisfaction Greater Efficiency Improved Resource

Management

Intervention: Relationship-Based Care

Relationship-based care is a transformation model and intervention that improves key care provider relationships within an organization:

Relationships with Patients and Families Relationship with Self Relationships with Colleagues

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Relationship-Based Care – Three Key Care Provider Relationships

The relationship between patients and their families and members of the clinical team belongs at the heart of care delivery.

Patient and family as the central focus

Respect and personal concern

Protection of dignity and well-being

Active engagement Intention to connect

The relationship with self is essential to maintaining each individual’s optimum health, for having empathy for the experience of others, and for being a productive member of an organization.

Skills and knowledge to manage stress

Ability to recognize personal needs and values

Willingness to balance work demands with one’s own physical and emotional health and well-being

The delivery of compassionate care requires a commitment by all members of the health care team to accept responsibly for establishing and maintaining healthy interpersonal relationships.

Open and honest communication

Respect Trust Consistent and

visible support

Patients & FamiliesPatients & Families ColleaguesColleaguesSelfSelf

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Intervention: Attending Nurse Role

Responsible Nurse/Attending Nurse

Expand staff nurse role.

Accountable for patient/family continuity and progression along the developed overall plan of care from admission to discharge

Ensures, along with the Attending MD, that patient care meets the unit’s clinical standards and vision of patient- and family-centered care

Develops and revises the patient care goals with the clinical care team daily

Coordinates meetings with clinicians for timely decision making and connects nurses to optimize handoffs across the continuum

Is the primary bedside communicator with the patient and family, discussing plan of the day, care progress, potential discharge, and answers questions/teaches/coaches

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Intervention: Hand-Over Communication

Passing patient-specific

information: From one caregiver to

another From caregiver to patient

and family Transfer of information

from one type of organization to another or to the patient’s home

Goal: To ensure patient care continuity and safetyGoal: To ensure patient care continuity and safety

SBAR: Hand-Over Communication Tool

This format should be used whenever a “hand-over” of patient responsibility occurs, i.e. shift to shift report, etc.

S-Situation: Identify yourself and position,

patient’s name and the current situation.

Describe what is going on with the patient.

B-Background: State the relevant history and

physical (H&P), physical assessment pertinent

to the problem, treatment/clinical course

summary and any pertinent changes.

A-Assessment: Offer your conclusion about the

present situation.

R-Recommendations: Explain what you think

needs to be done, what the patient needs and when.

Verify any critical information received, review the history, seek clarification, ask questions, and read back critical test results.

Verify any critical information received, review the history, seek clarification, ask questions, and read back critical test results.

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Pre-admission clinical data collection, along with screening and patient education, are key components of “knowing our patients”

Current data collection standards and tools vary for different populations (e.g. ED, Same-Day Surgery, Transfers)

At minimum, estimated discharge date and discharge disposition should be documented upon admission.

Intervention: Clinical data collection pre-admit

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Informs patients and families of goals Designed to invite feedback Includes patient and clinician compact

Intervention: Welcome Packet

Patient and Family NotebookPatient and Family NotebookDischarge Information

Envelope ChecklistDischarge Information

Envelope Checklist

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Intervention: Domains of Practice

Each clinical discipline articulated Domains of Practice - A sphere of activity or knowledge, the perspective and territory, which includes subject matter, the main agreed-on values and beliefs, the central concepts, the phenomena of interest and the methods used to provide answers in the discipline

Disciplines: Nursing, Chaplaincy, Child-Life, Dieticians, Medical Interpretation, Occupational Therapy, Pharmacy, Physical Therapy, Respiratory Care, Social Work, Speech-Language Pathology, Volunteers

Example 1 – Nursing: Nursing is the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations (ANA).

Creation of a caring, individualized therapeutic relationship with patients and families that promotes health and healing

Assessment, diagnosis, plan, implementation and evaluation of interventions to promote the best possible outcome; this process is done in partnership with patients, families and the health care team

Health teaching and promotion Delivery of safe, quality and evidence-based practice Collaboration and communication with all members of the health care team Clinical inquiry and ongoing professional development

Example 1 – Nursing: Nursing is the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations (ANA).

Creation of a caring, individualized therapeutic relationship with patients and families that promotes health and healing

Assessment, diagnosis, plan, implementation and evaluation of interventions to promote the best possible outcome; this process is done in partnership with patients, families and the health care team

Health teaching and promotion Delivery of safe, quality and evidence-based practice Collaboration and communication with all members of the health care team Clinical inquiry and ongoing professional development

Example 2 – Respiratory Care: Respiratory therapists focus on improving and maintaining the cardiopulmonary health of patients.

Set-up management and discontinuation of mechanical ventilation (both via artificial airway and face mask)

Administration and evaluation of the efficacy of aerosolized pharmacological agents Set-up management and discontinuation of extracorporeal life-support to patients in the ICUs Obtaining and analysis of arterial blood for gas exchange, pH and electrolytes Assessment, maintenance, replacement, reposition and discontinuation of artificial airways Education of patients and families on all aspects of respiratory care

Example 2 – Respiratory Care: Respiratory therapists focus on improving and maintaining the cardiopulmonary health of patients.

Set-up management and discontinuation of mechanical ventilation (both via artificial airway and face mask)

Administration and evaluation of the efficacy of aerosolized pharmacological agents Set-up management and discontinuation of extracorporeal life-support to patients in the ICUs Obtaining and analysis of arterial blood for gas exchange, pH and electrolytes Assessment, maintenance, replacement, reposition and discontinuation of artificial airways Education of patients and families on all aspects of respiratory care

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Create formal mechanism for daily communication between all members of the care team

Facilitate concise and timely communication

Communicate clear picture of patient’s planned course among all members of the care team

Intervention: Interdisciplinary Team RoundsIntervention: Interdisciplinary Team Rounds

“Interdisciplinary rounds keeps everyone on the same page. We all hear the same information at the same time so we can craft our plan of care in a way that’s best for the patient. It has had a noticeable impact on communication on our Unit.”

Team member, White 6 - Orthopaedics

“Interdisciplinary rounds keeps everyone on the same page. We all hear the same information at the same time so we can craft our plan of care in a way that’s best for the patient. It has had a noticeable impact on communication on our Unit.”

Team member, White 6 - Orthopaedics

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Communication: In-Room White Boards

A “communication basic” Supports knowledge of care team Builds relationships Articulates patient’s goal Keeps an eye on discharge Can be integrated with notebook

and other teaching tools Keeping the board current is

critical It’s only as good a resource as it

is used…

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iPhone and web application for sending/receiving instant messages to specific individuals or groups. Users can write their own message or use the Quick Messages available in the system.

Voalté iPhones send/receive phone calls over MGH secure wifi (no cell plan used).

Sender selects staff they are trying to reach via a list with their name/role and picture so no need to memorize who is carrying which phone

Enabling Technology: Smartphones

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Intervention: Quiet Times

Designated hours on inpatient units where activity and conversation is minimized to allow patients to rest

Most effective model is to have a period in the afternoon and during the night when quiet hours are observed

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Intervention: Discharge Follow-up Calls

100% of patients in the inpatient setting being discharged to home will be asked to consent to receiving a discharge follow-up call.

Calls are made within 24-48 hours We estimate 3-5 calls per day per nurse or attending nurse Average call time is 3-5 minutes Standard is two attempts to reach patient Scripts are utilized

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Intervention: Discharge Planning/Discharge Readiness Tool

Guides proactive discharge planning and is comprised of: General Information Work-up Functional Requirements Educational material Post-Discharge instructions Discharge Information

Discharge Checklist

Tools and workflow procedures, including checklists incorporating LEAN principles from Toyota

Other relevant information

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Intervention: Hourly Rounds – The Four Ps

Evidence-based research indicates that hourly rounding increases patient satisfaction, decreases fall rates, decreases skin breakdown rates, and increases staff satisfaction.

The Four Ps Presence: Establish personal connection at the beginning and end of each shift and with each hourly round

Pain: Assess and address patient’s pain

Positioning: Patient’s physical position and comfort; Positioning of needed items within reach

Personal Hygiene: Help with toileting

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Intervention: Business cards

Innovation Cluster Focus Areas *

Communication

Patient Engagement

Roles & Structures

Interventions ** Throughout Admission

Relationship-Based CareAttending Nurse Handover Rounding Checklist

Pre-AdmissionPre-Admit Data CollectionWelcome Packet

During AdmissionDomains of Practice Interdisciplinary RoundsBusiness CardsQuiet HoursHourly RoundingElectronic White BoardsIn Room White BoardsSmart PhonesHand Held/ Tablets

Post-DischargeDischarge Follow-up Phone Calls

Others as identified

Ed

uc

ation

Evaluation(Pre, During, Post)

Quantitative Qualitative•HCAHPS

•Leadership Influence over Professional Practice Environments (LIPPES)

•LOS

•Quality Indicators

•Patients Perceptions of Feeling Known (PPFKN)

•Readmissions

•Revised Perceptions of Practice Environment Scale (RPPE)

•Cost per Case Mix

•Staff Retention

•Focus Groups (Staff, Patients, Families, etc)

•Observations

•Survey of the Innovation Unit Expectations (SIUE-pre)

•Survey of the Innovation Unit Experiences (SIUE-post)

* The clusters are a lens with which we gain perspective on any particular intervention.

** May apply to any or all 3 of the cluster focus areas June 2013

Other measures as identifiedOther measures as identified

– Evaluation– Evaluation

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Throughput and Efficiency LOS Average Cost per Case Mix

Adjusted Discharge (CMAD) TSI bud/flex Wait time for bed to be ready Admits

Patient & Staff Satisfaction MD & RN Communication Responsiveness Cleanliness Noise reduction Staff satisfaction

Quality and Safety Readmission Rate Restraint Free Rate Falls/Pressure Ulcer Reduction Foley Catheter Days

Innovation Unit Metrics

Ellison 17 Ellison 18

QUALITY AND SAFETY

Patient-Centered Outcome MeasuresFalls per 1,000 Patient Days

Total Fall Rate 4.50 1.46 4.95 0.77 1.92 1.32 2.16 1.79 TBD 0.65 4.85 0.45Observed (N) 11 3 13 1 2 2 5 2 2 10 1

Falls with Injury per 1,000 Patient DaysFalls with Injury Rate 0.41 0.49 1.52 0.00 0.96 0.00 0.00 0.89 TBD 0.00 1.45 0.45Observed (N) 1 1 4 0 1 0 0 1 0 3 1

Hospital Acquired (HA) Pressure UlcersTotal HA Pressure Ulcer Prevalence Rate 0.0% 0.0% 6.9% 0.0% 0.0% 0.0% 0.0% 7.7% TBD NA 4.8% 4.2%Observed (N) 0 0 2 0 0 0 0 1 1 1

Hospital Acquired (HA) Pressure Ulcers Type II or GreaterTotal HA Pressure Ulcer Type II or Greater Prevalence Rate0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 7.7% TBD NA 4.8% 4.2%Observed (N) 0 0 0 0 0 0 0 1 1 1

RestraintsTotal Restraint Prevalence Rate 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 7.7% TBD NA 0.0% 0.0%Observed (N) 0 0 0 0 0 0 0 1 0 0

Peripheral Intravenous (PIV) Infiltrations - Pediatric/NeonatalTotal PIV Infiltration Prevalence NA NA NA 0.0% 0.0% 0.0% NA NA NA NA NA NAObserved (N) 0 0 0

Central Line-associated Bloodstream Infections per 1,000 Line Days (CLABSI)Total CLABSI Rate 6.54 NA 1.36 2.90 4.76 0.00 1.10 1.70 TBD NA 0.00 0.00Observed (N) 1 1 1 1 0 1 2 0 0

Note: metrics to be reported beginning FY 2012 Color Shading relative to Benchmark:Catheter-associated Urinary Tract Infections per 1,000 Device DaysVentilator-associated Pneumonia per 1,000 Vent Days

Massachusetts General Hospital - PCS Innovation Units Dashboard

Rate is better (lower) than benchmark.

Rate is worse (higher) than benchmark.

VascularBigelow 14

ObstetricsBlake 13

ICUBlake 12

NICUBlake 10

CICUEllison 9

MeasuresOrtho

White 6OncologyLunder 9

MedicineEllison 16

Pediatrics SurgeryWhite 7

PsychBlake 11

Innovation Unit Dashboard sample

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Average Length of Stay (ALOS) in Days

  BaselineInnovation

Period Change

Phase I Innovation Units 5.5 5.2 -5%

TOTAL MGH 5.9 5.9 0%

30-Day All Cause Readmission Rates

  BaselineInnovation

Period Change

Phase I Innovation Units 9.9% 8.9% -1.0

TOTAL MGH 11.3% 11.0% -0.3

Outcomes - Phase I

Data Sources: PATCOM, EPSI

Time Periods: Baseline FY11; Innovation Period begins March 2012. Average length of stay data include patient discharges through September 2013. Readmission data expressed as a percent of patient discharges beginning April 2012 through June 2013 with readmissions through July 2013.

ALOS April 2012-September 2013; Readmits April 2012– June 2013

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Average Length of Stay (ALOS) in Days

  BaselineInnovation

Period Change

Total Phase II Units 6.1 6.0 -2%

TOTAL MGH 5.9 5.9 0%

Data Sources: PATCOM, TSI

Time Periods: Baseline -Year ending March 2013; Innovation Period begins April 2013. Average length of stay data include patient discharges through October 2013.

ALOS - Phase II Early Results Overall

Discharge ALOS, April-September 2013

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Cost Impact – Phase I

Source: Direct Cost per CMAD data from PHS Finance (EPSI). Case mix adjusted using AP21 NY DRG weights.Source: Direct Cost per CMAD data from PHS Finance (EPSI). Case mix adjusted using AP21 NY DRG weights.

Average Direct Cost per Case Mix Adjusted Discharge (CMAD) decreased 3.6% for Innovation units between October 2011-March 2012 (Pre) and April 2012-June 2013 (Post).

Average Direct Cost per Case Mix Adjusted Discharge (CMAD) decreased 3.6% for Innovation units between October 2011-March 2012 (Pre) and April 2012-June 2013 (Post).

Inpatient Direct Cost per Case Mix Adjusted Discharge (CMAD)

$5,469

$7,219

$5,595$5,351$5,848

$5,394

$0

$1,000

$2,000

$3,000

$4,000

$5,000

$6,000

$7,000

$8,000

Phase I Innovation Units-General Care

Phase I Innovation Units-ICUs

Total Phase I Innovation Units

Pre Post

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Data Source: NDNQI

Time Periods: Baseline FY11; Innovation Period April 2012 through June 2013.

Notes: Data displayed are Falls with Injury and Pressure Ulcer Stage II or greater. ICUs excluded.

Quality & Safety Outcomes - Phase I

Falls, Pressure ulcers, CY13Q2

Pressure ulcer prevalence decreased from 1.75% to 1.41% of patients on Phase I units.

Fall rate decreased 23% over baseline FY11 on Phase I Innovation units.

Falls with Injury per 1,000 Patient Days

Falls with Injury per 1,000 Patient Days

Pressure Ulcer Prevalence (Stage II or Greater)

Pressure Ulcer Prevalence (Stage II or Greater)

0.0%

0.5%

1.0%

1.5%

2.0%

2.5%

3.0%

3.5%

4.0%

CY10Q4

CY11Q1

CY11Q2

CY11Q3

CY11Q4

CY12Q1

CY12Q2

CY12Q3

CY12Q4

CY13Q1

CY13Q2

0.00

0.10

0.20

0.30

0.40

0.50

0.60

0.70

0.80

0.90

1.00

CY10Q4

CY11Q1

CY11Q2

CY11Q3

CY11Q4

CY12Q1

CY12Q2

CY12Q3

CY12Q4

CY13Q1

CY13Q2

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HCAHPS Results – 2011 vs. 2012MGH-wide vs. Phase 1 Innovation Units

Survey MeasureMGH

2012

Change (2011 - 2012)

Innovation Units 2012

Change (2011 - 2012)

Nurse Communication Composite 81.0 +1.6 80.8 +4.5Doctor Communication Composite 81.6 -0.3 82.0 +0.5Room Clean 72.9 +3.1 70.6 +4.2Quiet at Night 48.5 +3.3 49.8 +6.2Cleanliness/Quiet Composite 60.7 +3.2 60.2 +5.2Staff Responsiveness Composite 64.9 +1.3 64.0 +1.7Pain Management Composite 71.9 +0.4 73.3 +3.7Communication About Meds Composite 64.0 +1.3 65.7 +6.8

Discharge Information Composite 91.2 +1.4 92.3 +2.7Overall Rating 80.1 +1.0 78.5 +2.4Likelihood to Recommend 90.5 +1.1 90.3 +2.4

• HCAHPS Data for Innovation Units includes 6 units for which data is available – Bigelow 14, Blake 13, Ellison 16, Lunder 9, White 6 and White. Data not available for ICU’s and Psych.

• Date pull: 3.04.13

KEY

2012 Score exceeds that of entire hospital

Rate of Improvement Exceeds that of the entire hospital

KEY

2012 Score exceeds that of entire hospital

Rate of Improvement Exceeds that of the entire hospital

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HCAHPS Results – 2012 vs. 2013 YTDMGH-wide vs. Phase 2 Innovation Units

KEY

Rate of Improvement Exceeds that of the entire

hospital

Survey Measure MGH 2013 YTDChange

(2012-2013)

Phase 2 Units 2013

April YTD Score

Change(2012 – April

2013 YTD)

Nurse Communication Composite 81.5 +0.5 82.0 +1.2Doctor Communication Composite 82.2 +0.6 81.8 +0.4Room Clean 74.3 +1.4 75.0 +1.6Quiet at Night 50.3 +1.8 51.4 +3.5Cleanliness/Quiet Composite 62.3 +1.6 63.2 +2.5Staff Responsiveness Composite 64.3 -0.6 64.5 -0.3Pain Management Composite 71.9 No Change 73.4 +2.3Communication About Meds Composite 64.6 +0.6 65.5 +2.2Discharge Information Composite 91.3 +0.1 91.6 +0.7Overall Rating 80.7 +0.6 80.3 -0.2Likelihood to Recommend 90.3 -0.2 90.5 -0.1

• * HCAHPS Data for Innovation Units includes 21 units for which data is available – Blake 6, Bigelow 9,11, Ellison 6,7,8,10,11,13, 14,19, Lunder 7,8,10, Philips House 20,21,22, White 8,9,10,11

• Date pull: 10.18.13

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Intervention: Discharge Follow-up Calls

Goal: 100% of patients in the inpatient setting being discharged to home will be asked to consent to receiving a discharge follow-up call.Goal: 100% of patients in the inpatient setting being discharged to home will be asked to consent to receiving a discharge follow-up call.

Number of units live (as of 10/18) 38

Calls made (since first go-live) 16,157

(23,000+ calls since program inception)

Call attempt rate 96%

Call completion rate 65%

Average call length ~5 minutes

Peak calling times 11:00 AM – 3:00 PM

Percent of calls with clinical advice or care coordination provided

22%

Percent of patients with questions about their discharge instructions

11%

Themes for Reward/Recognition Nursing Care (44%)

Doctors (10%)

Patient Call Manager Results (Discharges 4/5/13-10/18/13 from units live with PCM)

Patient Call Manager Results (Discharges 4/5/13-10/18/13 from units live with PCM)

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Are attempting transformational change Will help us quickly identify what works and what doesn’t

without ever losing sight of our patients goals Innovation and care redesign moving us closer to efficient,

cost-effective, high quality care that is patient- and family-centered and responsive.

Create the opportunity for evaluation and research inquiry that can to link patient-sensitive interventions specific to populations, enhancing care and potentially sustaining behavior over time.

Innovation Units

“We experience the essence of care in the moment when one human being connects to another. When compassion and care are conveyed through touch, a

kind act, through competent clinical interventions, or through listening and seeking to understand the other’s experience, a healing relationship in created.

This is the heart of Relationship-Based Care.”

”Relationship-Based Care, A Model for Transforming Practice”Mary Koloroutis, 2004

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Michelle Anderson, RN

White 7 General Surgery Unit

Sarah Ballard Molway, RN

Ellison 19 Thoracic Surgery Unit

Kelly Brown, RN

White 6 Orthopaedics Unit

Betty Ann Burns-Britton, RN

Lunder 9 Hematology/Oncology Unit

Claire Paras, RN

Phillips House 22 Medical/Surgical Unit

The Voice of the Attending Nurse