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79 Middleville RD. Northport, NY 11768 79 Middleville RD. Northport, NY 11768

 Dr. Edwin Oberstein, PC/Medicine Attending Physician Barbara Inskip RN, Utilization Management Rita Burgess Dr. Edwin Oberstein, PC/Medicine Attending Physician Barbara Inskip RN, Utilization Management Rita Burgess RN, Nurse Manager Pam Schultheis RN, Staff Nurse Cindi Jo Timmermann MSW Ad Hoc representation by Louise Burns RN (Tele Health) and Jean Murphy-Gustavson RN, ANP (CHF Clinic)

Unit 34: Med/Surg Telemetry ADC = 25, Average Hours of Care/Day = 5. 0 Unit 34: Med/Surg Telemetry ADC = 25, Average Hours of Care/Day = 5. 0 CHF LOS baseline: 10. 5 days CHF 30 -day readmission rate baseline: 33%

 Increase caregiver time at the bedside: Implemented solo nurse-to-nurse report Social Work Consult Increase caregiver time at the bedside: Implemented solo nurse-to-nurse report Social Work Consult completed for CHF patients within 24 hours of admission Mon-Fri Improve caregiver – patient communication CHF teaching started within 24 hours of admission Educate staff and patients on the use of My Health-e-vet and Telehealth programs

 Improve caregiver communication: Staggered IDT meeting times to facilitate attendance Implement CHF Goal Improve caregiver communication: Staggered IDT meeting times to facilitate attendance Implement CHF Goal worksheet for RNs to more easily track patient progress CHF LOS and readmission rate targets posted prominently in team offices and on unit Medical staff / RN “mini IDT meetings” between 1: 30 – 2: 30 p. m. to update patient goals for the evening / night tours

 Reducing Congestive Heart Failure length of stay by 25% by 9/1/10. Reducing Congestive Reducing Congestive Heart Failure length of stay by 25% by 9/1/10. Reducing Congestive Heart Failure readmission rate by 25% by 9/1/10. These aims are aligned with Northport VAMC’s strategic plan to implement a veteran centric model and to enhance the veteran’s experience within the facility (via improved caregiver communication, improved coordination of care and increased patient participation in care).

 Facility Length of Stay for Heart Failure DRGs for 1 st. Q FY Facility Length of Stay for Heart Failure DRGs for 1 st. Q FY 10: 10. 5 days Readmission Rates for Heart Failure DRGs for 1 st. Q FY 10: 33% Facility Length of Stay for Heart Failure DRGs for 3 rd. Q FY 10: 4. 73 days Readmission Rates for Heart Failure DRGs for 3 rd. Q FY 10: 16%

2009 ALOS Target 291 -MCC FY 2010 CHF LENGTH OF STAY (IN DAYS) 16 2009 ALOS Target 291 -MCC FY 2010 CHF LENGTH OF STAY (IN DAYS) 16 16 16 6. 6 6. 6 10 6. 6 5. 7 4. 5 5. 1 4. 6 4. 5 3. 4 Oct-09 Nov-09 Dec-09 Jan-10 Feb-10 Mar-10 Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10

2009 readmission rate FY 2010 CHF Target 2010 readmission rates READMISSION RATES 33% 33% 2009 readmission rate FY 2010 CHF Target 2010 readmission rates READMISSION RATES 33% 33% 34% 33% 33% 25% 25% 25% 22% 22% 21% 5% Oct-09 Nov-09 Dec-09 Jan-10 Feb-10 Mar-10 Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10

100% FY 2010 Patient Education Satisfaction Rates 96% 91% 90% 80% 70% 81% 72% 100% FY 2010 Patient Education Satisfaction Rates 96% 91% 90% 80% 70% 81% 72% 93% 79% 75% 67% 60% RN - Understood Explanation MD - Understood Explanation 50% 46% Explanation of new meds 40% Side Effects Explained 30% 20% 10% 0% 1 st Q '10 2 nd Q '10 3 rd Q '10

 Use standardized tools that don’t depend on BCC team presence. Include these guidelines Use standardized tools that don’t depend on BCC team presence. Include these guidelines in all new employee orientation. Continue to evolve the culture where extended length-of-stay just isn’t acceptable- it’s all about patient safety!

 Spread program to TCU and U 23 (Med-Surg). Continue to track CHF data; Spread program to TCU and U 23 (Med-Surg). Continue to track CHF data; start tracking Tele-Health enrollment rates. Explore LOS issues for other DRGs. Apply the lessons learned to ETOH withdrawal patients (implement CIWA protocol in Med-Surg)

Don’t assume to know either the problem or the answer before mapping it out Don’t assume to know either the problem or the answer before mapping it out with all stakeholders. Set the bar high! Involve front line staff early on- look for those innovators and early adaptors. Repetition is vital to create “stickiness”. Create buy-in by finding the “hook”- there may be several. Educate new staff about the program right awaycreate good habits. Celebrate successes (feed them and they will come).