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Speaking CFOBringing the Transfer Center Under the Care Management Umbrella
Judy Raimo, Director, Care Management and Patient Service Logistics
Molly Rank, Management Engineer, Performance Improvement
This presentation reflects the views of the presenters and not necessarily those of PeaceHealth.
Honored to be with you today!
43 years in healthcare, 38 within the
same system! 5 years in healthcare, after 14 years
at UL LLC, loving every moment
helping patients!
PeaceHealth Southwest Medical Center
PeaceHealth Mission
We carry on the healing mission of Jesus Christ by promoting
personal and community health, relieving pain and suffering, and
treating each person in a loving and caring way.
PeaceHealth – Rich History and Heritage
▪ Founded by two sisters from the fledgling order of the Sisters of St. Joseph of Peace in August 1890
– They left their New Jersey home on the Atlantic to travel to Washington state, arriving in Fairhaven, now knownas Bellingham
▪ They sold “Annual Hospital Tickets” for $10 each
▪ Possibly the first HMO in the United States to provide healthcare to this new lumber and fishing village
Now a Three-State System
Our Hospital – Southwest Washington
Learning Objectives
At the end of this presentation, you will be able to:
▪ Engage leaders and stakeholders (C-suites & referring
facilities, etc.) to more deeply understand the benefits of a
Transfer Center well-integrated with Care Management
▪ Describe the connection between patient flow, care
coordination and financial outcomes
▪ Identify risk points and implement mitigation strategies before
issues become barriers
To create a model that optimizes patient flow, organizational
structure, culture and language matter …
The question becomes, “How do we get to a culture of yes?”
Why does alignment matter?
▪ Because we need the white space … we need capacity for
movement to enable flow
“Tell me more …” A Humble Inquiry approach
▪ “Humble inquiry is the fine art of drawing someone out,
of asking questions to which you do not already know
the answer, of building a relationship based on curiosity
and interest in the other person.”
– Edgar H. Schein, Humble Inquiry
Examples of the Questions We Have Been Asked
▪ What is the case mix index (CMI) for the transfers we’re
receiving from Centralia, Ocean Beach, Morton?
▪ How does the LOS for patients who transfer compared to
those admitted through Direct Clinic Admissions, ED or Peri-
Op?
▪ How many patients have transferred from other facilities who
went directly to the ICU?
▪ Why did the admission status change after the patient went to
the Operating Room?
PeaceHealth Strategic Values & Priorities
▪ Clinical Safety Initiatives
▪ 5 Rights of patient placement
▪ Discharge milestones
▪ Length of Stay (LOS)
▪ Salaries and wages
▪ EBITDA
▪ Readmission reduction
▪ Integrated Behavioral Health
▪ Community Collaboratives
▪ Private rooms – Patient Engagement Scores
▪ Daily Management System / Unit LOS Goals
▪ Engaging the front line via Kaizens / Lean
“Vector of Metrics” (an IHI concept)
▪ LOS, days and hours– Facility, Unit, Provider, Disposition
▪ Time of discharge
▪ ED2IP (Emergency Department (ED) to Inpatient) times
▪ CMI (Case Mix Index)
▪ Readmissions
▪ LWBS (ED Left Without Being Seen)
▪ Market Share and Payor Mix
▪ Avoidable days, avoidable write-offs (Revenue Cycle)
Are you prepared to answer these questions?
Question?Why is this question
important?
How would you answer?
Where would you get the data?
How many of our transfers from
outside facilities are going
directly to ICU?
• Epic Reporting Workbench
• Central Logic Forefront
• How many total calls / month?
• How many total calls / week?
• How many total calls / day?
• How many total calls / hour of
the day?
• Which hours are heaviest?
• Access Center Manager
• Variance tracking, beyond
what we can capture
electronically
• Central Logic Advanced
Reporting
How much are we reimbursed for
the care provided to the patients
transferred from other facilities?
• Director Patient Financial
Services and Revenue Cycle
• Epic / Financial Reports
Poor patient outcome because
ED stabilization did not occur –
how often does this happen?
We’re taking a new type of call,
“Clinic to ED Concierge.”
How many of these calls can
we handle before caregiver
engagement suffers and we
start to lose patients?
Accepting patients from other
facilities is a financial growth
initiative with a profit margin.
Some of the Tools Supporting the “How”
Central Logic Advanced Reporting ™
Central Logic Advanced Reporting
Central Logic Advanced Reporting
Central Logic Advanced Reporting
Epic – Grand Central Discharge Milestones
Pulsara – Stroke & STEMI early notification
Qventus
Data Presentation in Addition to Epic
▪ Tableau – LOS Process Improvement Data Analysis
LOS: Unit-Specific Performance at Unit Level
Some stories …
Our anecdotes, supporting the need for metrics and measures that can be
operationalized – and personalized to meet our daily needs
Can we move to all private rooms?
▪ Patient satisfaction scores indicated our “quiet at night”
strategies weren’t enough to achieve our goal
▪ Moved to private rooms with
courage
▪ Surprised to discover
unexpected capacity
ED2IP: Visualizing the Facts – Pulling Together
▪ Clarity of expectations between ED
and Inpatient
– How long should it take?
• How long does it really take?
– What does our patient expect?
• What would you expect for your mother?
ED provider enters Bed Request
• This is when patient is dispositioned for admit
• ED RN enters .BEDNEEDS note
Admitting provider enters Order to Admit
Bed Management assigns bed
• Assignment considers .BEDNEEDS
Inpatient RN reviews chart, adds note with .READY
• Inpatient nursing calls ED to ask questions and say “ready for patient!”
Patient is transported to unit
• Inpatient nursing welcomes patient to unit
• Patient is pulled into bed in CareConnect, completing the Bed Request
ED2IP: Meaningful Measures
▪ Not just overall average – but how many times have we beat
our expectations?
ED2IP: Celebrating Collaboration
▪ Build employee excitement, recognition of their efforts!
▪ Achieve spread throughout community
– Training video, using our key workshop participants as patients
and caregivers
The Access Center Team at PHSW
Thank you!
For additional information, please contact Molly Rank
or Priscilla Glovatsky at PeaceHealth Southwest Medical Center
This presentation reflects the views of the presenters and not necessarily those of PeaceHealth.