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)iagnostic. Testing – monitoring of pertinent lab values, radiology reports, ECG, etc.
Elderwood Health Care at Lakewood February , 2009 Days Admission/Identified Issue(Problem) Rm #/Name 311 W P R leg ulcer TPR BP Team 1 2 3 4 Evenings O 2 sat I App O TPR BP Nights O 2 sat I / O TPR BP O 2 sat App 2/13 LBM A Unit 1 2 3 Daily Acuity Reporting Tool 2/13 Contact Prec for Poss. . C. Diff. P ? R leg LBM 2/5 Cipro ( R leg Cellulitis) completed 2/11 A P ? R leg LBM A R 2/14 stool c diff-pend 2/16 RLE Ven. Doppler R R R E E D D 1/6 WBC ? 3. 4(3. 9), Hgb 11. 4(10. 8) 1/6 BMP WNL Physician/Surgeon Rm #/Name 312 P TPR BP O 2 sat 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 cardiac sx 1/27 BNP 253, 250 D sx dehydr P sx dehydr resp sx A lungs GI sx R pain cardiac sx E CBC, BMP T, Th 2/12 BUN 33(wnl) TPR R pain E D 2/12 CBC--wnl O A lungs R pain E I resp sx A lungs 2/3 vanco (til 2/24) R O 2 sat App resp sx A 1/22 bumex bid, lasix BP / G Vanco L E D G L 2/12 Alk. Phos. 210 Physician/Surgeon Rm #/Name 313 D P TPR ? BUN BP O 2 sat I App O TPR / BP O 2 sat I O TPR App P sx dehyd A E A A A R E R P sx dehyd R behavior HP 240 q 4 h P sx dehyd E E D D D behavior R BMP q 2 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 O 2 sat
Outcomes Resident Outcomes Decreased Hospitalizations = Increased Satisfaction
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
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