Success of Discharge Calls to a Transitional Call Center

White Plains Hospital

Center for Cancer Care

We H a v e E x p a n d e d O u r C a t c h m e n t A r e a w i t h N e w S a t e l l i t e O f f i c e s

Since 2011 WPH has added 13 ambulatory facilities

A new multi specialty facility in Armonk was opened November 2015

WP Ambulatory Site

White Plains Hospital

H o s p i t a l A w a r d s & R e c o g n i t i o n

A b o u t US

• 2015 Statistics:

• 292 Beds

• 16,976 Inpatient Discharges

• 1,856 Births

• 56,865 ER Visits

• 15,815 Surgical Procedures

• 34,132 Cardiology Procedures

• 211,420 Radiology Procedures

• 1,813,209 Lab tests

Learning Objectives

1. Discover our hospital’s transformation of Discharge Call Center to Discharge Transitional Care Program dedicated to patient-centered care of our discharged patients and their families

2. Identify improved clinical outcomes including increased patient satisfaction, continuity of care, decreased readmission rates to benefit patients and your facility

3. Provided ideas for meeting goals and transparency throughout your organization

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Who Benefits from Discharge Calls? And How?

• Patients

• Family Members

• Care Givers

• Hospitals

• Serving as a continuity figure

• Offering assistance with emotional impact of chronic illness

• Imparting teaching regarding disease-specifics and medication

• Encouraging patients and families to be active participants in their care

• Prompting regular provider and specialty follow up

• Helping patients navigate the health care system

• Reviewing and providing general discharge information

• Deciphering and solving miscommunications

• Working with physician offices

• Readmissions and patient satisfaction

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Bottom Line Results from Discharge Phone Calls

Service Quality People Finance Growth

Increase patient

satisfaction

Improve clinical

outcomes

Reduce turnover Better payment Decrease readmissions

Reduce patient anxiety Decrease length of stay Create culture of

harvesting positives

Decrease audits Increase access

Reduce complaints Decrease adverse

events

Engage & reward

physicians, nursing

and all staff

Manage up

Accurate billing check Increase capacity

Reduce claims Reduce readmissions Service recovery

Increase patient

satisfaction survey

return rate

Increased staff

satisfaction

Increased hospital

revenue

Tremendous word of

mouth

Discharge Calls not only benefit patients but the hospital too

The Beginnings

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Growth of the Call Center

• Developed Discharge call center

• RN Inpatient

• RN ER

• Quality

• Meet quota

• Increased staff 2 call representatives

• Added 2 Per Diem RN positions

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Inpatient Focus

• General Discharge

• Serial Calls – disease specific

COPD

PNA

CHF

• Geisinger Scores

• Readmissions

• Care management

• Physician offices

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Index Admission Score

Jan Feb Mar Apr May Jun July Aug Sept Oct Nov Dec 2015 YTD

High 8-20

35 57 61 59 58 52 322

Medium 3-7

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34 40 44 29 36 215

Low 0-2

15 15 21 19 16 21 107

No Score 4 9 5 6 7 6 37

Geisinger Scores

In-Patient Survey Questions

• Do you have any questions on your discharge instructions?

• Were you able to make a follow-up appointment with the physician?

• Were you able to get your prescriptions filled?

• Do you know what those medications are for?

• If Surgical patient:

• - Are you able to move around on your own?

• - Do you have a Incentive spirometer

• - Do you know how to use it?

• - Do you know the s/s of infection, including incision care

• Are there any physicians, nurses or hospital staff that you would like us to recognize for doing a very good job?

• Do you have any specific comments about what we did well or how we could have improved your stay?

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Questions that require intervention

• Do you have any questions on your discharge instructions?

• We want you to be as comfortable as possible, have you been able to manage your pain?

• If Surgical patient:

• Are you able to move around on your own?

• Do you have a Incentive spirometer

• Do you know how to use it?

• Do you know the s/s of infection, including incision care

• Do you feel you have the resources to take care of yourself at home?

• Were you started on any new medications during this hospital stay?

• Were you able to get your prescriptions filled?

• Do you know what those medications are for?

• Do you know what side effects to watch for?

• Do you feel you have the resources to take care of yourself at home?

• Were you able to make a follow-up appointment with the physician?

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How long have you been waiting? Do you even think they remember we’re here?

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ER Focus

• Physician call schedule

• Director and NM input on question

• Call issues

Questions

• If there were any delays in your care or treatment, did a member of our staff keep you informed?

• Was your pain addressed during your stay?

• Have you been able to manage your pain?

• Did your discharge instructions give you the information you needed to care for yourself at home?

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Compliments:

Patient was EXTREMELY complimentary of staff who took care of him “ I couldn’t have had better care

anywhere, the nurses were INCREDIBLE”. He specifically noted that the staff was so attentive and so

knowledgeable, “there was this wonderful cohesiveness between them all and they went out of their way to do

whatever NEEDED to be done, not just what they were TOLD to do, so willing to help each other w/o being

asked”.

“The very best care from teams of nurses, MD’s, respiratory techs, foods hosts (especially Lulu who provided

such personalized care), I was really sick when I came in there and I am SO much better”. Patient stated that

“someone was in my room every hour checking on me, I really felt safe!”. Patient noted that she lives ½ in

Jupiter, FL “where those billionaires have built themselves one heck of a beautiful, state of the art hospital, but

I’ll tell you what, the care here was exceptional!”

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Opportunities:

Patient’s spouse stated that he understood on d/c that there were 3 new Rx’s to

start taking, when he went to CVS to pick up RX only Diamox Rx had been

received, no RX for Coreg or Crestor.

“This is the 2nd time they sent me home with inappropriate coverage for my BS”. If

he’d only listened to me on discharge I wouldn’t have suffered though these ups

and downs during this last week.

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“The degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.” Specifically several aims of a high quality care system include:

Patient-centered – providing care that is respectful of and responsive to individual patient preferences,

needs, and values and ensuring that patient values guide all clinical decisions.

Timely – reducing waits and sometimes harmful delays for both those who receive and those who give care.

Efficient – avoiding waste, in particular waste of equipment, supplies, ideas, and energy.

Equitable – providing care that does not vary in quality because of personal characteristics, such as gender,

ethnicity, geographic location, and socioeconomic status.

“Evaluating the Quality of Health Care”. E-Source Behavioral & Social Science Research. www.esourceresearch.org

HCAHPS

• How satisfied were you with the noise level during your stay in the hospital?

• Did the physician communicate clearly with you about your health and your treatment process?

• How was the responsiveness of the staff to your needs while in the hospital?

Domains:

• Communication

• Care transitions

• Responsiveness

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Did you receive a Discharge Phone call?

23

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

2014 2015

ED

Inpatient

% Completed Calls 2015

24

0

10

20

30

40

50

60

70

80

90

100

Jan.-June July-Dec

ED

Inpatient

Overall Satisfaction

25

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Q 1 Q 2 Q 3 Q 4

ED 2014

ED 2015

InPt 2014

InPt 2015

Readmission Data

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Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15 Aug-15WPH 13.4% 12.1% 11.6% 10.6% 10.2% 11.1% 10.3%

0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

14.0%

16.0%

% of Patients

Readmitted within

30 Days

WPH 30 Day All Cause Readmission Rate

Intervention March- May 2015

Were you ready for discharge? Do you understand your Discharge Instructions? Did you have the resources to care for your self at home?

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Quality Improvement

• Demographics accuracy with admission

• Visiting Nurse Service Issues

• Electronic medication prescribing – pharmacy information

• Prescriptions issues

• Pre authorization of medication issues

• Medical Supply delivering issue

• Diagnosis specific issues

• Vendor issues

• Communication with Medical Staff

• Documentation with Interdisciplinary Team

• New Incentives by Interdisciplinary Team – Thank You Cards

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Goals for 2016

• Added Ambulatory Surgery

• Interventional Radiology

• Transitional Care with increased education and calls

• Ensure physician appointments

• Continue focus to include compliance, HCAPHS scores, and Patient Satisfaction

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Call Center

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In summary, we established enhanced communication and built valuable relationships with our attending practices and our multi-disciplinary team. We have positively influenced best practice for our hospital using valuable patient feedback simply because we made the call to say “Hi! How are you feeling today?”