organizational theories topic 2

Sunday, October 16; 3:10 pm to 5:05 pm (Room 206)

2 5 3 0 3 4 5 LUNG PARTNERS IM PACT O N RED U CTIO N IN 30-DAY C O PD READMISSION RATES. R u sse ll A . A c e v e d o , W e n d v F a s c ia , L in d a R au c, J e n n if e r P e d le v ; R e s p ir a to r y C a r e , C r o u s e H o s p ita l, S y ra c u s e , N Y

Background: L u n g P a r t n e r s P r i m a r y R e s p i r a t o r y C a r e is a u n i q u e p r im a r y re s p ir a to r y care m o d e l fo r in -p a tie n t C O P D disease m a n a g em e n t. T h e re is a g re a t n e ed to im prove m a n a g e m e n t o f C O P D in th e h o sp ita l settin g . In th e hosp ital, care is m ostly delivered by h o sp ital-b ased physicians aid ed by extenders. T h e re are delays in care d u e to c o m m u n ic a tio n issues. T h e p lan a t discharge m ay n o t be carried o u t a t h o m e . In a h o sp italist m o d el, a p a tie n t’s care team is freq u e n tly d ifferen t on each readm ission. W ith th e g ro w in g n u m b e r o f p a tie n ts a n d th e flat o r decreas­ in g n u m b e r o f physicians, the R esp irato ry T h e ra p is t (R T ) is th e logical choice for C O P D disease m a n a g em e n t. I f th e R T has a p rim ary re la tio n sh ip w ith a C O P D p a tie n t for all h o sp ita l ad m issions a n d is actively involved in tra n sitio n to h o m e , th e frag m e n ta tio n o f care can be red u ced . P a tie n ts en ro lled in L u n g P artn ers will have a P rim a ry R T for th e initial a n d all su b se q u e n t hosp italizatio n s a n d w ill have L u n g P a rtn e r R T s as a resource w h en th ey are n o t in th e h o spital. T h e P rim ary R T is p o sitio n e d as the m a jo r physician p a rtn e r in th e m a n a g em e n t o f C O P D p atien ts. T h e P rim ary R T educates th e p a tie n t o n th e ir disease an d coaches disease m a n a g em e n t skills. T h e P rim a ry R T screens th e ir p a tie n t for co -m o rb id itie s. T h e se co -m o rb id ities are p o o rly addressed in th e h o sp ita l setting. A nxiety a n d D ep ressio n are m a jo r c o -m o rb id ities. Pro to co ls are in place for p a tie n ts to receive services based o n th e P rim a ry R T ’s assessm ents. T h e im p a c t o f th is p ro g ram o n 3 0 -d a y readm issions was evaluated. Methods: Since N o v em b er, 2 0 1 4 w e have en ro lled 231 p a tie n ts, w h ich is a b o u t 10% o f o u r C O P D p o p u ­ la tio n . T h r o u g h o u r Q u a lity Im p ro v e m e n t D e p a rtm e n t w e m easure th e 3 0 -d ay read m issio n rates for resp irato ry diseases o n L u n g P a rtn e r p a tie n ts, w h ich w e can d irectly influence. H o sp ital-w id e C M S 3 0 -d a y all cause C O P D readm issions was also evaluated. Results: F o r L u n g P artn ers p a tie n ts w e saw a sig n ificant red u c­ tio n in 3 0 day readm issions d u e to resp irato ry diseases by 2 8 % (p= 0 .0 1 7 6 ). W e also saw a sig n ificant re d u c tio n in to ta l C O P D C M S readm issions by 2 4 % (p= 0 .0 4 5 ). Conclusion: By p lacin g o u r R T s in a P rim ary R esp irato ry C are m odel w e w ere able to reduce 3 0 -d a y readm ission rates. T h e R T d e p a rtm e n t has m oved fro m a task o rie n te d to disease m a n a g e m e n t focus a n d utilizes R T s to the full e x te n t o f th e ir licensure. R T s can be very successful in th is role. S p o n so re d R esearch - N o n e

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BUILDING A STRONG FO UNDATION T O LEAD YOUR TEAM TH R O U G H TRANSFORMATIONAL CHANGE. N a ta s h a T v s o n : R e s p ir a to r y C a r e D e p a r t m e n t , C e n t r a l D i v is io n , C a r o l i n a s H e a l t h c a r e S y s te m . C h a r l o t t e ,

N C

Background: H e a lt h c a r e re fo r m h a s c re a te d a n i m m e d ia te d e m a n d fo r le a d ers to tr a n s itio n a w a y fr o m u tiliz in g o u t d a t e d p e r f o r m a n c e im p r o v e ­ m e n t s tra te g ie s to so lv e c o m p le x , m u lti- fa c t o ria l issues. L e a d e rs are n o w e x p e c te d to b e tr a n f o r m a tiv e b y e n g a g in g in s o p h is ti c a te d p r o b le m s o lv in g te c h n iq u e s t o a c h ie v e s u s ta in a b le a n d m e a n in g fu l c h a n g e . I n o r d e r f o r R e s p ira to r y T h e r a p y le a d e rs to b u i l d su cc e ssfu l p ro g r a m s t h a t a re r o o te d in tr a n s f o r m i n g c a re a s o lid in f r a s tr u c tu r e m u s t b e in p la c e to s u p p o r t r a p id c h a n g e in c lin ic a l p ra c tic e a n d th o u g h t . C a n th e f o u n d a t i o n fo r tr a n s f o r m a tio n a l c h a n g e b e b u i l t b y re d e s ig n i n g a d e p a r t m e n t ’s h ie ra rc h y to a llo w fo r g re a te r o p e r a tio n a l e ffic ie n c ies a n d th e c r e a t io n o f v ia b le stra te g ies to im p r o v e c lin ic a l o u tc o m e s? Method: A s tre n g th s , w eak n esses, o p p o r tu n i tie s , a n d th re a ts ( S W O T ) an aly sis w as c o n d u c t e d o f th re e , d iv erse R e s p ira to r y C a r e d e p a r t m e n t s w i t h i n a larg e h e a lth c a re sy ste m to d e te r m in e i f c re a t in g a d iv is io n a l le a d e rs h ip o rg a n iz a tio n a l s t r u c t u r e w o u l d e lim in a te silos a n d c re a te s u s ta in a b le o p e r a tio n a l e fficien cies. A c o st an aly sis fo llo w e d to d e te r m in e t h e i m p a c t to t h e b u d g e t. A th re e p h a se , tw o y e a r im p le m e n ­ t a tio n s tra te g y w as d e v e lo p e d to h e lp th e te a m m a t e s u n d e r s t a n d a n d a d ju s t to th e t r a n s itio n as w ell as th e n e w ly c re a te d ro les w i t h i n th e n e w le a d e rsh ip h ie ra rc h y . I t w as im p le m e n te d a fte r re c eiv in g a p p ro v a l fr o m th e E x e c u tiv e te a m . Results: A c ro s s -f u n c t io n a l le a d e rs h ip te a m w as c re a te d b y a lig n in g th r e e s e p a ra te le a d e r s h ip m o d e ls i n to a s in g le C e n t r a l D iv is io n o r g a n iz a tio n s tru c tu re . A ro b u s t c ro s s -t ra in in g p ro g r a m a n d a C e n t r a l D iv is io n P R N P o o l w e re c re a te d to assist t h e d iv is io n in a c h ie v in g its 3 % Y T D o v e rtim e goal. O v e r tim e g o als w e re a c h ie v e d a n d s u s ta in e d fo r 2 0 1 4 a n d 2 0 1 5 . P r e m ie r p o d u c tiv ity in d e x p e rc e n ta g e s s ta b liz e d fr o m 1 1 8 % to 1 0 5 % b y 2 0 1 5 . P r e m i e r la b o r e x p e n s e in d e x p e rc e n ta g e s s ta b liz e d f r o m 1 2 4 % to 1 1 2 % b y 2 0 1 5 . T h e C e n t r a l D iv is io n F T E b u d g e t a llo w e d fo r th e u se o f 175 F T E ’s to flex to v o lu m e a n d s u p p o r t fa c ility sp e c ific s ta ffin g n e ed s. Press G a n e y te a m m a t e e n g a g e m e n t sco res im p r o v e d fr o m a T i e r 3 sc o re to T i e r 2 d u r i n g t h e im p l e m e n t a t i o n p e rio d . Conclusion:The C e n t r a l D iv is io n R e s p ira to r y C a r e D e p a r t m e n t h a s re a liz e d its g o a l o f g a in in g o p e r a tio n a l e ffic ie n c ies a n d h a s a s tr o n g f o u n d a t i o n b u i l t to s u p p o r t th e d e m a n d s o f h e a l th c a re re fo rm . S p o n s o re d R e s e a rc h - N o n e

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IM PLEM ENTATION OF A NEWLY DEVELOPED PATIENT AND FAMILY SATISFACTION SURVEY FO R RESPIRATORY CARE - A PILO T STUDY. L isa T v l e r , l o e v lv n n C o v n e , L a u r a S a lo m o n e : R e s p ir a to r y C a r e . T h e C h i l d r e n ’s H o s p ita l o f P h ila d e lp h ia . C h e r r y H i l l , N J

Background: P a tie n t a n d fam ily satisfaction surveys are o fte n u tilized by o rg a n iz a tio n s to m easure qu ality a n d satisfaction w ith n u rsin g a n d physician care. T h e se surveys m o st o fte n do n o t in clu d e qu estio n s reg ard in g respiratory therap ists (R T ) th erefo re in fo rm a tio n o n satisfaction w ith R T care is o ften unavailable. A q u a lity p ro je c t targ etin g p a tie n t fam ily satisfaction o f R T care was in itia te d a n d a R T based survey developed. A p ilo t s tu d y was c o n d u c te d to assess process m e th o d s (d eliv ery /retu rn ), survey qu estio n s, a n d p relim in ary sat­ isfaction scores. Methods: A p a p er based survey was develo p ed u sing m o d ified q u e stio n s from a valid ated n u rsin g tool. Five q u estio n s u sing a fo u r p o in t Likert scale (never to always) m e a su rin g c o m m u n ic a tio n practices, con sisten cy o f care, co u rtesy a n d respect, in fo rm a tio n sharing, a n d ability to voice co n ce rn s w ere in c lu d e d as well as on e o p e n -e n d e d q u e stio n . Q u e stio n n a ires w ere ra n d o m ly given o u t o n tw o u n its, p e d ia tric in tensive care u n it (IC U ) a n d an acu te care u n it (A C U ), to p a tie n ts a n d fam ilies w h o received resp irato ry care services. A s tan d a rd ize d dialo g u e was p ro v id e d for co n sisten cy in c o m m u n ic a tio n . Surveys w ere h a n d delivered a n d retrieved by staff. Results: 55 surveys (n= 55) w ere c o m ­ p leted a n d re tu rn e d . T h e c h art provides th e results for q u estio n s 1 to 5. 4 4 /5 5 (8 0 % ) o f th e o p e n -e n d e d q u e stio n w ere an sw ered w ith positive feedback a n d / o r areas o f c o n ce rn . N o p a tie n ts o r fam ilies (0 % ) re p o rte d d ifficu lty in u n d e r­ s tan d in g , need ed s u p p o rt, o r refused to c o m p le te th e survey. D e liv e ry /re tu rn p ro v ed to be m o st ch allen g in g for staff, c o m m e n ts in c lu d e d tim in g o f p a tie n t/ p a re n t a p p ro a ch for initial delivery (IC U ) a n d ab ility to re tu rn to p ick up (A C U ) as th e ir c h ie f p ro b lem s. Conclusion: P a tie n t a n d fam ily satisfaction surveys for resp irato ry care d e p a rtm e n ts can be successfully im p le m e n te d in th e IC U an d A C U . T h e re are challenges to a d m in isterin g a p a p er based to o l in th e h o spital setting. W h ile th e p relim in ary overall scores w h ere goo d , c o m m u n ic a tio n an d con sisten cy in care are p o te n tia l area o f im p ro v em e n t w ork. I t is im p o r ta n t to n o te , these results m ay be skew ed d u e to R T d riv en p a tie n t selection. F u tu re w o rk w ill in c lu d e ex p an sio n o f survey use to all p a tie n ts receiving R T services, fin d in g m o re efficient m eans for delivery a n d re tu rn , a n d to tra c k response rate. S p o n so re d R esearch - N o n e

2 5 3 1 5 4 9 REDUCING NON-CLINICALLY INDICATED BRO N CH O D ILA TOR THERAPY ON N O N -IC U FLOORS AT UPHS USING A THERAPIST DRIVEN PRO TO CO L. M a r g ie P ie rc e . M i c h a e l F ra z e r , H e n r v S m i t h . D a v id D o m z a ls k i. A n d r e w R o ss: R e s p ir a to r y C a r e . H o s p ita l o f t h e U n iv e r s ity o f P e n n s y lv a n ia , P h ila d e lp h ia , P A

Introduction: R esp irato ry T h e ra p is t d riv en p ro to co ls vs. p h y sician -d irected R T o rd ers have d e m o n stra te d cost savings to h ospitals a n d im p ro v ed R T resource u tiliz a tio n in m u ltip le studies. T h e U niv ersity o f P ennsylvania H e a lth System R T d e p a rtm e n ts p ilo ted a m u lti-h o sp ital b ro n c h o d ila to r p ro to c o l in an effort to reduce v ariability o f b ro n c h o d ila to r orders, im p ro v e q u a lity o f care an d R T resource utilizatio n . Methods: O u r m u lti-h o sp ital team used PI m e th o d ­ ology to assess ro o t causes o f no n -clin ically in d ic a ted b ro n c h o d ila to r orders. A T D P assessm ent form was develo p ed to stan d ard ize th e assessm ent process. Phase 1: R T ’s a t H U P , P A H , a n d P P M C used th e assessm ent form for a 2-w eek d a ta collection p e rio d to assess ap p ro p ria te n e ss o f physician o rd e re d resp irato ry therap y . D u rin g th e follow ing 8 weeks th e R T used th e T D P fo rm on a p ilo t m edical u n it a n d in terv en ed w ith rec o m m e n d atio n s fo r o rd e r changes based o n the assessm ent findings. Phase 2 in c lu d e d C h este r C o u n ty H o sp ital, an d a d d ed a seco n d m edical u n it to th e original p ilo t u n its. Phase 3 ad d ed surgical u n its a t H U P a n d P P M C w hile C C H a n d P A H su stain ed th e p ilo t o n m e d ­ ical u n its. Results: P re-in te rv e n tio n d a ta sho w ed a n average o f 2 0 % o rd ered b ro n c h o d ila to rs w ere n o t clinically in d ic a ted (range 5 -3 3 % ). D u rin g Phase 1, n o n -clin ically in d ic a ted b ro n c h o d ila to rs w ere re d u c ed to 10% . D u rin g Phase 2, th e p ro v id e r o rd e r screen was redesigned to im p ro v e accuracy w h e n selecting freq u en cy o f b ro n c h o d ila to rs. Phase 3 in c lu d e d th e a d d itio n o f 2 surgical units. H U P red u ced n o n -clin ically in d ic a ted b ro n c h o d ila to r ord ers to 5 % a n d P P M C to less th a n 8% . U P H S R T d e p a rtm e n ts calculated savings o f $ 8 2 ,5 0 0 in su p p ly a n d m e d ic atio n costs d u rin g th e p ilo t. Providers re p o rte d im p ro v ed c o m m u n i­ catio n , im p ro v ed q u a lity o f care, a n d th a t R T re c o m m e n d atio n s w ere clinically ap p ro p ria te . Conclusions: T h e U P H S p ro je c t d e m o n stra te d T h e ra p is t D riv en Pro to co ls red u ce unn ecessary th e ra p y a n d im proves q u ality o f care by ensure p a tie n ts receive th e a p p ro p ria te resp irato ry therap y . By red esig n in g th e p ro v id er o rd e r screen, o v e rn ig h t th e ra p y was red u ced a n d frequency o f tre a tm e n ts was m o re a p p ro p ria te ly o rd ered . R T p a tie n t assessm ents increased a n d a tre n d to w a rd low er m e d ia n cost p er p a tie n t was id en tified . O rd e rin g pro v id ers a n d R T ’s re p o rte d positive feedback o f th e p ilo t. U P H S results are in lin e w ith p re­ vious o b servations fro m 2 R C T ’s. U P H S R T d e p a rtm e n ts are seeking m edical b o a rd approval for h o sp ital-w id e R T d riv en b ro n c h o d ila to r p ro to co l. S p o n so red Research - N o n e

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