Thursday, February 9, 2012

Reducing Readmissions through Guidelines (and other performance improvement techniques)

This article in Health Leaders Media provides a wonderful example of how to utilize performance improvement tools and principles in order to reduce readmissions. "UPMC Hamot, Lancaster (PA) General Hospital, and Muncie, IN–based Indiana University Health Ball Memorial Hospital have readmission rates that beat Medicare's HospitalCompare dataset national average in three key areas: 30-day readmission rates for heart attacks, 30-day readmission rates for heart failure, and 30-day readmission rates for pneumonia." The entities attribute their success in large part to the following interventions:
  • Guidelines:
    • "We researched best practices, and we standardized those practices."... "Then we put together teams of physicians and caregivers that care for the population of patients we were focusing on and developed standardized treatment guidelines that were then put into use."
    • "The organization now has more than 200 guidelines in place, each created by an interdisciplinary team with a physician champion."
  • Checklists
    • Heart failure (HF) patients receive a home health referral upon discharge.
    • Telehealth whenever possible.
    • Scale with the blood pressure monitors hooked up to the phone line.
    • Review weight every day.
  • Standardization:
    • Standardizing paperwork that is exchanged between hospital and after-care facilities.
  • Multidisciplinary (in this case, cross-institutional) Teams
    • "We took it a step further when we worked on heart failure. We created a heart failure skilled care order set and met with the administrator and director of nursing to make sure what we were putting on the order set could be used anywhere."
  • Redesigning Care Processes:
    • Inpatient HF clinic staffed by nurse practitioners.
    • Link the specialists in the hospital to patients' primary care physicians and SNFs.
    • HF coach calls discharged HF patients three times within the first week to make sure they are following up with appointments and understand their medications.
A few additional PI techniques come to mind that are not mentioned in this article, but would be a natural adjunct to the initiative, and could help to ensure excellent outcomes:
  • Disseminate Data to Physicians, Nurses, and Other Staff to generate awareness.
  • Provide Feedback in the event that there is a "failure" in a process in order to ensure that individual practitioners learn of any gaps in their behavior.
  • Create Profiles of Providers in order to generate further awareness about team and individual performance.

1 comment: