Take Control of Your Patient Flow Initiatives€¦ · MINING DATA THAT MAKES SENSE 18. All-Cause Readmissions •Patient Flow Working Definition: Hospitalization followed by a readmission

Take Control of Your Patient Flow InitiativesMICHELLE SKINNER, RN, BSN, MBA

9/27/2019 Presentation Information [OPTIONAL] 2

In a pickle?

3

In a jam?

Goals

• Tips For Generating Organizational Buy-In

• How to Mine Data that Makes Sense

• Attainable Goal Development

• Overcoming Setbacks and Challenges

• Celebrating Success

4

The Magic Recipe…

5

It Depends!

Why Patient Flow?

6

7

Value Equation in Healthcare

8

9

V(Value)

C(Cost)

Q(Quality)

S(Service)

A(Access)

+ +

=

10

V(Value)

C(Cost)

Q(Quality)

S(Service)

A(Access)

+ +

=

11

C O M M U N I C A T I O N

12


Cultural Goals

• Organizational Buy-In

• Connection to the cause

• Voice

• Empowerment

• Leading from the front

• Celebrating Success

13

14

Kotter’s 8 Step Change Model

1

CREATE

Sense of

Urgency 2

BUILD

Guiding

Coalition

3

FORM

Strategic

Vision &

Initiatives

4

ENLIST

Volunteer

Army5

ENABLE

Action by

Removing

Barriers

6

GENERATE

Short Term

Wins

7

SUSTAIN

Acceleration

8

INSTITUTE

Change

15

“If you want to build a ship, don’t drum up

the men to gather wood, divide the work,

and give orders. Instead, teach them to

yearn for the vast and endless sea.”

― Antoine de Saint-Exupéry

Th

rou

gh

pu

t Ste

eri

ng

Co

mm

itte

e

ED Admit Taskforce

DC TaskforceTransportation

Workgroup

EPIC

Case Management/UR Readmissions

Other Throughput

Committees/ActivitiesHAC

Have an organized structure

Shape or Reduce Demand:

Improve transitions and post-hospital care to reduce readmissions for high-

risk populations

• Readmission reduction program

• Inpatient superutlizer targeted care management

Use enhanced care management and coordination of services for patient

populations with complex medical care and social needs.

• Targeted Case Management: ED superutilizers

Decrease complications and harm, and subsequent increases in hospital

length of stay, resulting from errors and hospital-acquired conditions

• HAC identification/reduction

Match Capacity and Demand:

Use hospital-wide patient flow planning huddles and real-time demand and

capacity problem solving

• Safety huddle

• Bed huddles

• Implement use of HEV during bed huddles

Use early recognition of high census and “surge” protocols to expedite plans

for accommodating unplanned increases in patient volume

• Implement and Hard Wire Patient Flow and

Capacity Management Plan

Redesign the System:

Use proactive discharge planning focused on patients’ medical-readiness

criteria for discharge

• Discharge planning

• Discharge checklist

Use a framework

Readmissions and Serial AdmissionsGENERATING ORGANIZATIONAL BUY-IN

MINING DATA THAT MAKES SENSE

18

All-Cause Readmissions

• Patient Flow Working Definition:

▪ Hospitalization followed by a readmission (for any diagnosis) within 30 days of discharge.

• CMS Definition:

▪ The 30-day All-Cause Hospital Readmission measure is a risk-standardized readmission rate for beneficiaries age 65 or older who were hospitalized at a short-stay acute-care hospital and experienced an unplanned readmission for any cause to an acute care hospital within 30 days of discharge.

20

Readmissions and Serial Admissions

0.00%

2.00%

4.00%

6.00%

8.00%

10.00%

12.00%

14.00%

16.00%

Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Apr-18

All Cause Readmissions

Readmits READ

DC Year-Month 2018-4

Row Labels Prior ICD10Desc Count of PriorCID10

871 SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 H 10

291 HEART FAILURE & SHOCK W MCC 7

313 CHEST PAIN 4

193 SIMPLE PNEUMONIA & PLEURISY W MCC 4

470 MAJOR HIP AND KNEE JOINT REPLACEMENT OR 3

190 CHRONIC OBSTRUCTIVE PULMONARY DISEASE W 3

292 HEART FAILURE & SHOCK W CC 2


246 PERCUTANEOUS CARDIOVASCULAR PROCEDURES W 2

372 MAJOR GASTROINTESTINAL DISORDERS & PERIT 2

Diagnosis code Prior to Readmission

Readmits READ

DC Year-Month 2018-4

Row Labels DRGTxtI10 Count of Final DRG ICD-10


291 HEART FAILURE & SHOCK W MCC 9

641 MISC DISORDERS OF NUTRITION,METABOLISM,F 5

313 CHEST PAIN 3

193 SIMPLE PNEUMONIA & PLEURISY W MCC 3

280 ACUTE MYOCARDIAL INFARCTION, DISCHARGED 3

292 HEART FAILURE & SHOCK W CC 3

638 DIABETES W CC 2

689 KIDNEY & URINARY TRACT INFECTIONS W MCC 2

640 MISC DISORDERS OF NUTRITION,METABOLISM,F 2

Diagnosis code For Readmission

Details

Serial AdmissionsakaInpatient Superutilizers • 5 or more admissions in a defined

calendar year.

• Data from January 2017 – December 2017

• Total Pts = 6229

• IP Superutilizer: 88 = 1.4% of all inpatients

23

LOS ReductionGENERATING ORGANIZATIONAL BUY-IN

OVERCOMING SETBACKS AND CHALLENGES

24

Month# of Pts LOS >

Expected

Total Number of

Patients%

Sum of Days >

ExpectedSum of Day Actual LOS %

Jan 370 729 51% 1489 4054 37%

Feb 385 723 53% 1444 3988 36%

Mar 394 742 53% 1467 4215 35%

Apr 353 730 48% 1368 3853 36%

May 378 730 52% 1325 3853 34%

Jun 355 720 49% 1428 3915 36%

Jul 394 755 52% 1768 4423 40%

Aug 364 732 50% 1495 4090 37%

Sep 370 748 49% 1269 3881 33%

Oct 367 713 51% 1211 3513 34%

Nov 309 621 50% 941 3140 30%

Dec 346 666 52% 1184 3532 34%

Jan-17 388 763 51% 1490 4154 36%

Feb-17 289 556 52% 1433 3457 41%

Mar-17 341 717 48% 1357 3793 36%

Apr-17 351 699 50% 1327 3743 35%

May-17 431 785 55% 1722 4522 38%

Jun-17 372 712 52% 1320 3757 35%

Jul-17 354 730 48% 1277 3672 35%

Aug-17 396 775 51% 2078 4663 45%

Sep-17 337 702 48% 1374 3729 37%

Oct-17 360 692 52% 1488 3861 39%

Nov-17 354 710 50% 1466 3912 37%

Dec-17 365 756 48% 1392 3858 36%

Jan-18 465 826 56% 2684 4736 57%

Feb-18 385 694 55% 1685 4049 42%

Mar-18 476 807 59% 1838 4644 40%

Apr-18 428 756 57% 1845 4428 42%

Grand Total 9573 18726 51% 38482 102363 38%

Potential

actual

patient

days that

could be

saved.

Length of Stay(LOS)

Count of Hour DC Hour DC

Yr-Wk 0-11 12-23 Grand Total % DC

2018-1 2 31 33 6%

2018-2 5 23 28 18%

2018-3 7 20 27 26%

2018-4 3 23 26 12%

2018-5 6 35 41 15%

2018-6 6 30 36 17%

2018-7 7 25 32 22%

2018-8 5 31 36 14%

2018-9 2 25 27 7%

2018-10 6 26 32 19%

2018-11 5 30 35 14%

2018-12 2 40 42 5%

Grand Total 56 339 395 14%

DC Before Noon- Pilot

Order Written to DC Overall Stats-October-December (“Control Data”)

Unit NAvg

(Min)

Stdev

(Min)

Max

(Min)

Min

(Min)

Median

(Min)CV

A 469 186 160 1555 0 146 86%

B 456 226 291 3116 3 149 129%

C 395 199 316 4730 1 138 159%

D 338 161 148 1647 13 119 92%

E 224 330 854 10197 1 156 259%

F 47 214 121 642 29 192 57%

All 1929 211 371 10197 0 145 176%

Unit N Avg

(Min)

Stdev

(Min)

Max

(Min)

Min

(Min)

Median

(Min)

CV (Stdev/Avg)

A 121 144.1 84.647 462 15 128 59%

B 120 174.7 149.351 1312 23 140.5 85%

C 116 160.0 102.447 548 24 131 64%

D 90 150.4 94.423 580 30 124.5 63%

E 63 217.4 216.597 1240 32 150 100%

F 36 188.1 119.845 513 19 153 64%

Overall546 166.6 129.945 1312 15 135.5 78%

** Arrows in relation to prior month

Order Written to DC Overall Stats-February (“Control Data”)

29


30

“Sound strategy

starts with having

the right goal.”

-Michael Porter

Strategic Goals

• TJC requirement

• Outlying organizations

• Transitional care back to community or

critical access hospital

• Lower cost of care

• Care closer to home

• Maximize margin

• Capacity

• Surge plan

31

ED SuperutilizersCELEBRATE SUCCESS

32

ED Superutilizers• What is a “Superutilizer”?▪ 5 or more Emergency

Department visits in one year

• What’s appropriate for your organization and population?

• Look at the data for trends. ▪ Families?

▪ Certain diagnosis?

▪ Time of month?

▪ Day of week?

33

ED Superutilizers

• Shape or reduce demand.

• Right care, right place, right time

• Lower cost of care

• Reduce readmissions

34

Patient # of visits in past 12

months

2016

# of visits in past 12

months

2018

1 496 205

2 145 128

3 114 76

4 107 73

5 92 55

ED Superutilizers- Rolling 12 Months

• Define

• Analyze

• Determine next steps:

▪ Primary Care

▪ Intensive Case Management

▪ Community Resources

36

ED Superutilizers- Strategy

37

38


9/27/2019 Presentation Information [OPTIONAL] 39

“To achieve great things, two

things are needed: a plan and not

quite enough time.”

― Leonard Bernstein

Operational Goals

• Alignment-

▪ What is the problem we are trying to solve?

• Why patient flow?

▪ LOS

▪ Capacity

▪ Right patient, right place, right time

▪ Surge

• Define and clarify

▪ Physician

▪ Nursing

▪ Ancillary and support

▪ Administration

• Monitor/measure40

Decision to Admit ->DepartATTAINABLE GOAL DEVELOPMENT

41

Timely Emergency Department Care

(Data from Hospital Compare as of 9/5/18)

Measures

Hospital

Other Very

High Volume

Hospitals State

Average

Other Very

High Volume

Hospitals

National

Average

Emergency department volume Very High

Average (median) time patients spent in the emergency department,

before they were admitted to the hospital as an inpatient. A lower number

of minutes is better.

429 Minutes 416 Minutes 334 Minutes

Average (median) time patients spent in the emergency department, after

the doctor decided to admit them as an inpatient before leaving the

emergency department for their inpatient room. A lower number of

minutes is better.


Average (median) time patients spent in the emergency department

before leaving from the visit. A lower number of minutes is better. 143 Minutes 193 Minutes 171 Minutes


before they were seen by a healthcare professional. A lower number of

minutes is better.


42



Measures

Hospital

Other Very

High Volume

Hospitals State

Average

Other Very

High Volume

Hospitals

National

Average









minutes is better.






minutes is better.


43

Decision to Admit -> Depart



Measures

Hospital

Other Very

High Volume

Hospitals State

Average

Other Very

High Volume

Hospitals

National

Average









minutes is better.






minutes is better.


44



Measures

Hospital

Other Very

High Volume

Hospitals State

Average

Other Very

High Volume

Hospitals

National

Average









minutes is better.






minutes is better.


45

Decision to Admit -> Depart

46

What is the problem we are trying to solve?MINING DATA THAT MAKES SENSE

47

0.80%

0.69%

0.70%

0.52%

0.71%0.55%

0.48%0.49%

0.71%

0.46%

0.41%

0.58%

0.00%

0.10%

0.20%

0.30%

0.40%

0.50%

0.60%

0.70%

0.80%

0.90%

0

1,000

2,000

3,000

4,000

5,000

6,000

7,000

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

LWBS %

Total Pts Seen LWBS%

48

0.80%

0.69%

0.70%

0.52%

0.71%0.55%

0.48%0.49%

0.71%

0.46%

0.41%

0.58%

0.00%

0.10%

0.20%

0.30%

0.40%

0.50%

0.60%

0.70%

0.80%

0.90%

0

1,000

2,000

3,000

4,000

5,000

6,000

7,000


LWBS %

Total Pts Seen LWBS%

49

4.13%

3.13%

3.55%

3.11%

4.52%

2.85%

3.70%2.98%

4.09%

3.22%

3.11%

3.08%

0.00%

0.50%

1.00%

1.50%

2.00%

2.50%

3.00%

3.50%

4.00%

4.50%

5.00%

0

1,000

2,000

3,000

4,000

5,000

6,000

7,000


LPTC %

Total Pts Seen LPTC%

0.80%

0.69%

0.70%

0.52%

0.71%0.55%

0.48%0.49%

0.71%

0.46%

0.41%

0.58%

0.00%

0.10%

0.20%

0.30%

0.40%

0.50%

0.60%

0.70%

0.80%

0.90%

0

1,000

2,000

3,000

4,000

5,000

6,000

7,000


LWBS %

Total Pts Seen LWBS% Linear (LWBS%)

50

4.13%

3.13%

3.55%

3.11%

4.52%

2.85%

3.70%2.98%

4.09%

3.22%

3.11%

3.08%

0.00%

0.50%

1.00%

1.50%

2.00%

2.50%

3.00%

3.50%

4.00%

4.50%

5.00%

0

1,000

2,000

3,000

4,000

5,000

6,000

7,000


LPTC %

Total Pts Seen LPTC% Linear (LPTC%)

51

“Success is the sum

of small efforts

repeated day in and

day out.”

-Robert Collier

At The Eleva Group, we support our clients in accomplishing their most mission-critical

initiatives. Our team works collaboratively to build processes, develop people, and create

programs to improve performance and ensure long-term sustainability and success.

We use a data-driven assessment and implementation approach to help clients realize

and sustain results. We leverage high-quality, in-depth, subject matter experts and

collaborative partners in all engagements. The Eleva Group’s measure of success is

watching our clients elevate their ability to serve their communities.

Collaborative | Proactive | Sustainable | Scalable

The Eleva Group: Alignment

Thank You & Questions

53

Documents

Take Control of Your Patient Flow Initiatives€¦ · MINING DATA THAT MAKES SENSE 18. All-Cause Readmissions •Patient Flow Working Definition: Hospitalization followed by a readmission