CLC Storyboard_MDR_PMMC Oct 2015
- 1. Box 5: Solution Approach RESULTS Box 1: Reason For Action Box 8: Confirmed State ANALYSIS AND NEXT STEPS: Multidisciplinary rounds have led to a decrease in Excess Days and Medicare ALOS at PMMC. Standard work , best practices, and lessons learned are being shared with PSJHE. Next steps include the following: • Continue to hardwire the process at PMMC and collect real-time reasons for excess days (MDI) • Spread the process to all inpatient units at PMMC M-F • Observe PSJHE process and coach for more consistency & participation • Work to include patient and family in multidisciplinary rounds Acknowledgements Executive Sponsor: Grace McBride Process Owners: Vanessa Hiland, Roxann Barber Team Members: Peg Lagrassa, Sally Sanchez, Rex King, Larry Lillwitz, Elsa Huedem, Gina Wilderspin, Diane Romito, David Lee BTI Facilitators: Jason Egan, Omar Ordaz, Kelsey Knutti We are not effectively utilizing the professional expertise and knowledge of a multidisciplinary team in a collaborative coordinated fashion to optimize clinical outcomes in an effective manner. This can result in excess days. In Scope: Patients managed by hospitalist services at PMMC Trigger: Patient admitted to hospitalist group Done: Transition to next level of appropriate care Box 2: Initial State Improving Length of Stay Through Multidisciplinary Rounds Box 3: Target State If We Did This… Then We Would Expect These Results… If we had physician involvement in Multi- Disciplinary Rounds… ...Then we would have immediate action taken on pending items. If we were to enhance the whiteboard to include multiple disciplines… ...Then we would expect a complete picture of patient needs and a standard communication process. If we were to standardize the current process of rounds… ...Then we would have a more uniform process for rounds and future roll out to other units Initial State Characteristics: • De-centralized patient information • Lack of staff buy-in & engagement • Lack of patient involvement • Lack of ownership of process Target State Characteristics: • Patient & family participation • Standard, visible information sharing • Consistent plan of care information communicated across all disciplines 0.0 1.0 2.0 3.0 4.0 5.0 6.0 Jan '14 Feb '14 Mar '14 Apr '14 May '14 Jun '14 Jul '14 Aug '14 Sep '14 Oct '14 Nov '14 Dec '14 Jan '15 Feb '15 Mar '15 Apr '15 May '15 Jun '15 Jul '15 Aug '15 Days PMMC Medicare ALOS Jan '14 - Aug '15 0 1 2 3 4 5 6 7 Jan '14 Feb '14 Mar '14 Apr '14 May '14 Jun '14 Jul '14 Aug '14 PMMC Medicare ALOS Jan '14 - Aug '14 0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50% 55% Jan '14 Feb '14 Mar '14 Apr '14 May '14 Jun '14 Jul '14 Aug '14 Sep '14 Oct '14 Nov '14 Dec '14 Jan '15 Feb '15 Mar '15 Apr '15 May '15 Jun '15 Jul '15 Aug '15 PMMC Excess Days and Failure Rate - Medicare Patients Jan ‘14 – Aug ‘15 Excess Days % of Total Days Failure Rate Domain Metric Base Target 2015 Trend People Pre-Implementation Satisfaction Survey 3.95 / 5 4.5 / 5 4.57 / 5 Service Medicare LOS 4.7 days 4.4 4.3 (YTD) Service HCAHPS score - MD Explain percentile 80% 89% 86% (Q3) Quality HCAHPS score - RN Explain percentile 72% 86% 83% (Q3) Disciplines Involved: • Hospitalists • Nursing • Care Management • Therapies • Nutrition • Clinical Documentation • Pastoral Care • Pharmacy Standard Discussion Points: • Introduction of patient • Medical care plan summary • Patient / Family concerns • LOS, GMLOS, and variances • Discharge needs / barriers • Medication issues, alternatives • Other disciplinary issues, barriers, needs Domain Metric Baseline Target People Pre-Implementation Satifaction Survey 3.95 / 5 4.5 / 5 Service Medicare LOS 4.7 4.4 Service HCAHPS score - MD Explain percentile 80% 89% Service HCAHPS score - RN Explain percentile 72% 86%