Executive Summary
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Patience Nehikhare
THEQUALITYIMPROVEMENTINITIATIVE.docx
Summary 764 Words
Execut ive Summary
Pat ience Nehikhare
Grand Canyon Universit y
November 24, 2019
Purpose
The purpose of t his qualit y improvement init iat ive is t o lower t he lengt h of pat ient
st ays and improve care coordinat ion. Improving and reducing lengt h of st ay (LOS)
improves financial, operat ional, and clinical out comes by decreasing t he cost s of care
for a pat ient . It can also improve out comes by minimizing t he risk of hospit al-acquired
condit ions.
Hospit al inpat ient care makes up nearly one-t hird of all healt hcare expendit ures in t he
U.S., wit h an average LOS of 4.5 days and an average cost of $10,400 per day (Agency
or Healt hcare Research & Qualit y, 2014). Opt imizing and reducing LOS improves
financial, operat ional, and clinical out comes by decreasing t he cost s of care for a
pat ient , not only in facilit y expenses and supplies but in st affing and premium pay. It
can also improve pat ient out comes by minimizing t he risk of hospit al-acquired
condit ions (Jennings, 2015).
Prolonged consult response t imes also emerged as a key fact or for Oakbend Memorial
Hospit al. Average t ime from consult order t o signed consult not e hovered around 18-
hour qualit y improvement s, wit h 20 percent of all consult s having a t ime from order t o
document at ion of consult t ime of great er t han 24-hours. Consult delays not only
impact ed pat ient s but providers as well, wit h pot ent ially negat ive effect s on pat ient
sat isfact ion, t ime t o care, care coordinat ion, and st aff sat isfact ion. Furt her analysis of
t he consult t o not e process revealed several, dist inct opport unit ies for improvement ,
including:
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'to' + non-base form: signed
a/the + infinitive: the consult
· Inconsist ent nursing document at ion process.
· Unnecessary variat ion among pract ices and providers.
· Phone calls t o inform receiving providers of t he consult request ed, which
inadvert ent ly creat ed delays.
· Lack of oversight of consult processes.
Target ed dat a and analyt ics were needed for monit oring and report ing of progress in
relat ion t o goals. Wit hout specific performance informat ion, providers were eit her
unaware of issues or unable t o gauge t he impact of any effort s t hey made t o address
consult delays, readmissions, or LOS.
Improving int erdisciplinary communicat ion and discharge process
From implement ing t he role of an UM regist ered nurse (RN), who assist s wit h denials
management and avoidable day ident ificat ion and t rending, t o int egrat ing case
managers int o morning huddles wit h discharge planning as part of huddle discussions,
Memorial expanded roles and int roduced several new processes t o close
communicat ion gaps and eliminat e unnecessary discharge delays.
Case managers assess each pat ient ’s risk for 30-day hospit al readmission. For high-
risk pat ient s, case managers follow up and engage pat ient s for 30-days post -
discharge. Case managers also closely follow up wit h select pat ient s t hat have a
hist ory of frequent readmissions. By adding an ext ra hospit alist liaison t o t he case
management depart ment , Memorial also looked t o enable clearer communicat ion
bet ween t he case managers and t he hospit alist s.
Opt imizing crit ical processes t o meet improvement benchmarks required
organizat ional buy-in, especially from t he hospit alist s, who provide care t o more t han
70 percent of Oakbend Memorial’s pat ient s. Hospit alist s have embraced t he
st rat egic effort and implement ed several changes t o furt her reduce LOS including:
· Developing a det ailed handoff process, including a progress not e t hat provides
informat ion about t he medical t reat ment plan and act ivit ies t hat need t o be
complet ed prior t o discharge. The progress not es help improve care coordinat ion for
weekend providers and help ensure care progression avoiding unnecessary weekend
discharge delays.
· Case managers and unit managers receive a daily list of ant icipat ed discharges t o
improve communicat ion bet ween hospit alist s, case managers, and unit managers.
· Daily assignment s of case managers and t heir cont act informat ion are sent t o
hospit alist s via secure t ext , helping t o ensure hospit alist s are aware of who t o
cont act for assist ance wit h discharge planning and care coordinat ion.
· Hospit alist s also receive a pat ient list t hat shows t he providers which pat ient s have
cent ral lines, indwelling urinary cat het ers, t elemet ry monit ors, and out st anding labs
and diagnost ics. This t arget ed list also includes LOS and t he pat ient ’s st at us
(inpat ient or observat ion), which assist s hospit alist s in t he discharge planning
process.
In addit ion t o implement ing t hese new processes, members of t he case management
leadership t eam review dat a weekly from t he EMR on LOS out liers. The t eam also
ident ifies pot ent ial out liers and works wit h t he case managers and providers t o
ident ify addit ional discharge opt ions.
RESULTS
Oakbend Memorial’s commit ment t o a dat a-driven, mult i-pronged approach t o
reducing LOS has produced t he desired result s in one year, including:
· $2 million in cost savings, t he result of decreased LOS and decreased ut ilizat ion of
supplies and medicat ions.
· 0.47-day percent age point reduct ion in LOS.
· Improved care coordinat ion and physician engagement have successfully reduced
LOS.
· The 30-day readmission rat e has remained st able.
· Three percent increase in t he number of discharges occurring on t he weekend.
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REFERENCES
Agency for Healt hcare Research and Qualit y. (2014). Overview of hospit al st ays in t he
Unit ed St at es, 2012.Ret rieved from ht t p://www.hcup-
us.ahrq.gov/report s/st at briefs/sb180-Hospit alizat ions-Unit ed-St at es-2012.pdf
Jennings, N. (2015). Inpat ient care – Calculat ing t he cost of lengt h of st ay. Hospit als &
Healt h Net works. Ret rieved from ht t ps://www.hhnmag.com/ art icles/3378-inpat ient -
care