Transcript Insert Session Title

Reducing Unnecessary Hospital
Transfers
Ellen Rychlik, RN, BSN
Elderwood Health Care at Lakewood
Faculty Disclosures
Ellen Rychlik, RN, BSN has disclosed that she
has no relevant financial relationship(s).
Learning Objectives
By the end of the session, participants will be
able to:
• Identify the Risks Associated with Hospitalization of
the Frail Elderly
• Define Impact of Reduction in Unnecessary Hospital
Transfers on Overall Resident/Family/Staff
Satisfaction
• Understand Strategical Elements of Process
Improvement
Facility Demographics
• Elderwood Health Care at Lakewood
• Hamburg, New York
• 166 Beds
• Privately Owned
Reducing Unnecessary
Hospitalization
Risks Associated with Hospitalization
• Increased delirium
• Sleep deprivation
• Immobility
• Dehydration
• Falls
• Malnutrition
• Pressure Ulcers
Improving Quality of Life
• Decrease interruption of daily care to
the resident
• Increase treatment options in-house
• Maintain function ability
Data Collection and Analysis
Hospitalization Tracking Record
• Transferring Physician
• Admission to Hospital
• Time of Transfer
• Symptomatollogy Necessitating Hospital
Transfer
• Admitting Diagnosis
Hospitalization Tracking Record
• Identification of Case Review Strategical
Opportunities
• Improved Advanced Care Planning
• Identification of Educational Opportunities for
Future Staff Development
• Readily Identifies Causes and Trends that
Result in Residents Being Transferred to the
Hospital
Goals of the LTC Industry
•
•
•
•
•
Maximize Function Ability
Maintain Skin Integrity
Minimize Weight Loss
Prevent Immobility
Maintain Quality of Life
Daily Acuity Reporting Tool
• Reviewed daily by the IDT
• Uses the acronym PARED with:
P – Identifying the (P)roblem
A – Choosing an appropriate (A)ction
R – Monitoring of residents (R)esponse
E – Evaluating the (E)ffectiveness of the
action or intervention in treatment of the
problem
D – (D)iagnosticTesting – monitoring of
pertinent lab values, radiology reports,
ECG,etc.
Elderwood Health Care at Lakewood
February
, 2009
Days
Admission/Identified Issue(Problem)
Rm #/Name311 W
P
R leg ulcer
TPR
BP
I
App
O
TPR
BP
O2sat
Nights
I
/
O
TPR
2/13 Contact Prec for Poss.. C. DiffP ? R leg
LBM
2/5 Cipro ( R leg Cellulitis) completed 2/11
A
P ? R leg
LBM
A
P ? R leg
LBM
A
R
R
R
E
E
E
E
D
D
D
1/6 WBC?3.4(3.9), Hgb 11.4(10.8)
1/6 BMP WNL
BP
O2sat
BP
O2sat
App
R 2/14 stool c diff-pend
2/16 RLE Ven. Doppler
D
Team 1 2 3 4
Evenings
O2sat
2/13 LBM
A
Unit 1 2 3
Daily Acuity Reporting Tool
Physician/Surgeon
Rm #/Name 312
P
TPR
BP
O2sat
1/29 Contact Prec for C. Diff
I
App
? BUN
O
TPR
P sx dehydr
2/13 Flagyl done
P
GI sx
1/23 US RUQ:kidney cysts
TPR
sx dehydr
P sx dehydr
resp sx
A lungs
A lungs
GI sx
R pain
GI sx
R pain
cardiac sx
E
O
resp sx
A lungs
2/3 vanco (til 2/24)
R
O2sat I
App
resp sx
A 1/22 bumex bid,lasix
BP
/
R pain
cardiac sx
E
cardiac sx
E
E
CBC,BMP T, Th
D 2/12 CBC--wnl
1/27 BNP 253,250
2/12 BUN 33(wnl)
D
G
Vanco
L
D
G
L
D
G
L
2/12 Alk. Phos. 210
Physician/Surgeon
Rm #/Name313 D
P
A
TPR
?BUN
HP 240 q4h
R
E
BP
O2sat
I
App
O
TPR
/
BP
O2sat
I
O
TPR
App
P sx dehyd
P sx dehyd
P sx dehyd
A
A
A
R behavior
R
E
E
E
D
D
D
behavior
R
BMP q2 wks
D
1/23 BUN 42 (29,36)
Physician/Surgeon
KEY:
Problem (VS,Symptoms,Assessment)
Action (MD Orders/Nurse Follow Thru)
Response (Patient Response)
Evaluation(Re-assesment/Need for N.O.'s)
Diagnostic Testing (Results/Repeat Date)
BP
O2sat
Outcomes
Resident Outcomes
Decreased Hospitalizations =
Increased Satisfaction
Hospitalization Case Review
90
80
70
60
50
# of Re s i de nts
40
30
20
10
Transferred
0
2006
2007
Ye a r
2008
Admitted
Outcomes
• Regulatory Outcomes
DART = Elimination of Clinical/Delay in
Treatment Deficiencies
• Quality of Service
Experts in Gerontology Treating Residents
at Home
Outcomes
Enhanced Staff Performance
Exciting and Rewarding Environment with
Coinciding Reduction in Turnover
Effect on Staff’s Routine Work
They are Given the Tools they Need to
Work More Efficiently (Actionable
Information)
Improved Organization & Management Structure
Outcomes
Financial Outcomes
Keeping the Cost Down by Avoiding
the Costly Risks Associated with
Hospitalizations
Improved Quality of Life for the Resident
Questions