Strategic Management and Organizational Change

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

2530345 LUNG PARTNERS IMPACT ON REDUCTION IN 30-DAY COPD READMISSION RATES. R ussell A. A cevedo, W e n d v Fascia, L in d a Rauc, Jennifer Pedlev; R esp ira to ry C are , C ro u se H o sp ita l, Syracuse, N Y

Background: L u n g P a r tn e rs P r im a ry R e s p ira to ry C are is a u n iq u e p rim ary resp ira to ry care m odel for in-patient C O P D disease m anagem ent. There is a great need to improve m anagem ent o f C O P D in the hospital setting. In the hospital, care is mostly delivered by hospital-based physicians aided by extenders. There are delays in care due to com m unication issues. T he plan at discharge may not be carried out at hom e. In a hospitalist model, a pa tien t’s care team is frequently different on each readmission. W ith the growing num ber o f patients and the flat or decreas­ ing num ber o f physicians, the Respiratory Therapist (RT) is the logical choice for C O P D disease m anagem ent. If the R T has a prim ary relationship with a C O P D patient for all hospital admissions and is actively involved in transition to hom e, the fragm entation o f care can be reduced. Patients enrolled in Lung Partners will have a Prim ary R T for the initial and all subsequent hospitalizations and will have Lung Partner RTs as a resource when they are no t in the hospital. T he Primary R T is positioned as the m ajor physician partner in the m anagem ent o f C O P D patients. T he Primary R T educates the patient on their disease and coaches disease m anagem ent skills. T he Prim ary RT screens their patient for co-m orbidities. These co-m orbidities are poorly addressed in the hospital setting. Anxiety and Depression are m ajor co-morbidities. Protocols are in place for patients to receive services based on the Prim ary R T ’s assessments. T he im pact o f this program on 30-day readmissions was evaluated. Methods: Since November, 2014 we have enrolled 231 patients, which is about 10% o f our C O P D popu­ lation. T hrough our Q uality Im provem ent D epartm ent we measure the 30-day readmission rates for respiratory diseases on Lung Partner patients, which we can directly influence. Hospital-w ide CM S 30-day all cause C O P D readmissions was also evaluated. Results: For Lung Partners patients we saw a significant reduc­ tion in 30 day readmissions due to respiratory diseases by 28% (p= 0.0176). W e also saw a significant reduction in total C O P D CM S readmissions by 24% (p= 0.045). Conclusion: By placing our RTs in a Primary Respiratory Care model we were able to reduce 30-day readmission rates. T he R T departm ent has moved from a task oriented to disease m anagem ent focus and utilizes RTs to the full extent o f their licensure. RTs can be very successful in this role. Sponsored Research - N one

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BUILDING A STRONG FOUNDATION TO LEAD YOUR TEAM THROUGH TRANSFORMATIONAL CHANGE. N atasha T v so n : R esp ira to ry C a re D e p a rtm e n t, C e n tra l D iv is ion , C a ro lin a s H ea lth ca re S ystem . C h a rlo tte ,

N C

Background: H ealth ca re re fo rm has created an im m ed ia te d e m an d for leaders to transition aw ay from u tiliz ing o u td a te d p erfo rm ance im prove­ m e n t strategies to solve com plex , m ulti-facto ria l issues. Leaders are now expected to be tran fo rm ative by engag ing in soph istica ted p rob lem solving techn iques to achieve susta inable an d m ean ing fu l change. In o rd e r fo r R esp ira to ry T h e rap y leaders to b u ild successful p rog ram s th a t are ro o ted in tran sfo rm in g care a so lid in fras truc tu re m ust be in place to su p p o rt rap id change in clinical practice an d th o u g h t. C an th e fo u n d a tio n for tran sfo rm atio n a l change be b u ilt by redesign ing a d e p a r tm e n t’s h ierarchy to allow fo r g rea te r opera tiona l efficiencies an d th e c reation o f viable strategies to im prove clinical outcom es? Method: A streng ths, weaknesses, o p p o rtu n ities , and th reats (S W O T ) analysis was c o n d u cted o f th ree , diverse R esp ira to ry C are d ep artm en ts w ith in a large healthcare system to de te rm in e i f c reating a divisional leadership o rgan izational s tru c tu re w o u ld e lim inate silos and create susta inable o pera tiona l efficiencies. A cost analysis follow ed to de te rm in e th e im pact to th e budget. A th ree phase, tw o year im p lem en ­ ta tio n strategy was developed to help the team m ates u n d e rs tan d and adjust to the tran sitio n as well as the new ly created roles w ith in the new leadership hierarchy. I t was im p lem en ted after receiving approval from the Executive team . Results: A cross-functional leadership team was c reated by aligning th ree separate leadership m odels in to a single C en tra l D iv ision o rgan ization struc tu re . A ro b u st c ross-tra in ing p rog ram and a C en tra l D iv ision P R N Pool w ere c reated to assist th e div ision in ach iev ing its 3 % Y T D overtim e goal. O v ertim e goals w ere achieved and susta ined for 2 0 1 4 and 2015 . P rem ier p oduc tiv ity index percentages stab lized from 118% to 105% by 2015 . P rem ier labo r expense index percentages stablized from 124% to 112% by 2015 . T h e C en tra l D iv ision F T E b u d g e t allow ed for the use o f 175 F T E ’s to flex to vo lum e and su p p o rt facility specific staffing needs. Press G aney team m ate engagem en t scores im proved from a T ie r 3 score to T ie r 2 d u rin g th e im p lem en ta tio n period . Conclusion:The C en tra l D iv ision R esp ira to ry C are D e p a r tm e n t has realized its goal o f ga in ing o pera tiona l efficiencies and has a s tro n g fo u n d a tio n b u ilt to su p p o rt th e dem an d s o f healthcare reform . S ponsored Research - N o n e

2531464

IMPLEMENTATION OF A NEWLY DEVELOPED PATIENT AND FAMILY SATISFACTION SURVEY FOR RESPIRATORY CARE - A PILOT STUDY. Lisa T v le r, loev lvnn C o v n e , L au ra Salom one: R esp ira to ry C a re . T h e C h ild re n ’s H o sp ita l o f Philade lph ia . C h e rry H ill, N J

Background: Patient and family satisfaction surveys are often utilized by organizations to measure quality and satisfaction w ith nursing and physician care. These surveys m ost often do no t include questions regarding respiratory therapists (RT) therefore inform ation on satisfaction w ith R T care is often unavailable. A quality project targeting patient family satisfaction o f RT care was initiated and a RT based survey developed. A pilot study was conducted to assess process m ethods (delivery/return), survey questions, and prelim inary sat­ isfaction scores. Methods: A paper based survey was developed using modified questions from a validated nursing tool. Five questions using a four po in t Likert scale (never to always) m easuring com m unication practices, consistency o f care, courtesy and respect, inform ation sharing, and ability to voice concerns were included as well as one open-ended question. Questionnaires were random ly given ou t on two units, pediatric intensive care un it (ICU ) and an acute care unit (ACU), to patients and families who received respiratory care services. A standardized dialogue was provided for consistency in com m unication. Surveys were hand delivered and retrieved by staff. Results: 55 surveys (n=55) were com ­ pleted and returned. T he chart provides the results for questions 1 to 5. 44/55 (80% ) o f the open-ended question were answered w ith positive feedback and/ or areas o f concern. N o patients or families (0% ) reported difficulty in under­ standing, needed support, or refused to com plete the survey. Delivery/return proved to be m ost challenging for staff, com m ents included tim ing o f patien t/ parent approach for initial delivery (ICU ) and ability to return to pick up (ACU) as their chief problems. Conclusion: Patient and family satisfaction surveys for respiratory care departm ents can be successfully im plem ented in the IC U and A CU. T here are challenges to adm inistering a paper based tool in the hospital setting. W hile the prelim inary overall scores where good, com m unication and consistency in care are potential area o f im provem ent work. I t is im portan t to note, these results may be skewed due to RT driven patient selection. Future w ork will include expansion o f survey use to all patients receiving R T services, finding m ore efficient means for delivery and return, and to track response rate. Sponsored Research - N one

2531549 REDUCING NON-CLINICALLY INDICATED BRONCHODILATOR THERAPY ON NON-ICU FLOORS AT UPHS USING A THERAPIST DRIVEN PROTOCOL. M arg ie P ierce. M ichae l Frazer, H e n rv S m ith . D av id D om zalsk i. A n d rew Ross: R esp ira to ry C are . H o sp ita l o f th e U n iversity o f P ennsylvania , P h ilad e lp h ia , PA

Introduction: Respiratory Therapist driven protocols vs. physician-directed RT orders have dem onstrated cost savings to hospitals and im proved R T resource utilization in m ultiple studies. T he University o f Pennsylvania H ealth System R T departm ents piloted a m ulti-hospital bronchodilator protocol in an effort to reduce variability o f bronchodilator orders, improve quality o f care and R T resource utilization. Methods: O u r m ulti-hospital team used PI m ethod­ ology to assess root causes o f non-clinically indicated bronchodilator orders. A T D P assessment form was developed to standardize the assessment process. Phase 1: R T ’s at H U P, PAH, and PPM C used the assessment form for a 2-week data collection period to assess appropriateness o f physician ordered respiratory therapy. D uring the following 8 weeks the R T used the T D P form on a pilot medical unit and intervened w ith recom m endations for order changes based on the assessment findings. Phase 2 included Chester C ounty H ospital, and added a second medical un it to the original pilot units. Phase 3 added surgical units at H U P and PP M C while C C H and PAH sustained the pilot on m ed­ ical units. Results: Pre-intervention data showed an average o f 20% ordered bronchodilators were not clinically indicated (range 5-33% ). D uring Phase 1, non-clinically indicated bronchodilators were reduced to 10%. D uring Phase 2, the provider order screen was redesigned to im prove accuracy w hen selecting frequency o f bronchodilators. Phase 3 included the addition o f 2 surgical units. H U P reduced non-clinically indicated bronchodilator orders to 5% and PPM C to less than 8%. U PH S RT departm ents calculated savings o f $82,500 in supply and m edication costs during the pilot. Providers reported im proved com m uni­ cation, improved quality o f care, and that R T recom m endations were clinically appropriate. Conclusions: T he U PH S project dem onstrated T herapist Driven Protocols reduce unnecessary therapy and improves quality o f care by ensure patients receive the appropriate respiratory therapy. By redesigning the provider order screen, overnight therapy was reduced and frequency o f treatm ents was m ore appropriately ordered. R T patien t assessments increased and a trend toward lower median cost per patien t was identified. O rdering providers and R T ’s reported positive feedback o f the pilot. U PH S results are inline w ith pre­ vious observations from 2 R C T ’s. U PH S R T departm ents are seeking medical board approval for hospital-wide R T driven bronchodilator protocol. Sponsored Research - N one

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