Volume Volume 23 23Number Number XX 7Month AprilXX, 5, 2012 2013
Hospital of the University of Pennsylvania
KEEP YOUR EYE ON THE GOAL! Eliminating preventable deaths and preventable readmissions by July 1, 2014 is the key goal of Penn Medicine’s Blueprint for Quality and Patient Safety. Since beginning in July 2011, the initiative has led to reductions in both areas, but, as PJ Brennan, MD, cautioned, we’re not there yet. With fewer than 500 days left, the final push is on. Brennan, the Health System’s chief medical officer and a senior VP, compared the single-minded effort required to reach our goal to NASA’s goal in the 1960s to get a man on the moon by the end of that decade. “If you went to Cape Canaveral back then – or Cape Kennedy as it was called – or Mission Control in Houston and asked anyone what his job was, that person would reply: put a man on the moon. That was the mantra throughout NASA. “Eliminating preventable readmissions and mortality is our focus,” he said. “It will take everyone’s efforts to reach the goal.”
`` Earlier this year, PJ Brennan, MD, spoke at HUP’s “500 days and counting” event, highlighting how far we’ve come towards reaching our goal of eliminating preventable deaths and preventable readmissions by July 2014, but stressing the importance of staying focused on the goal to succeed.
Reaching Out Post Discharge While not every situation leading to a readmission can be controlled, eg, the impact of patient demographics, some can be resolved before they bring the patient back to the hospital. Working in partnership with an interdisciplinary team from both the in- and outpatient sides of cardiac care, the CICU developed a program to follow up with patients most at risk for readmission. This included those admitted for heart failure, with chest pain, for a cardiac intervention or with a VAD.
INSIDE Speaking with HUP’s Leaders............................2 10 Years of FACT Accreditation..............................3 Survey Says...............................4 Heartfelt Thanks........................4
Nurses called patients 48 hours after their discharge and then once a week for three weeks, asking key questions, eg, Do you have any complications? Are you able to get your medications? Do you understand your medications? “We specifically wanted clinical nurses with cardiac experience to make the calls because they are better able to answer patients’ disease-specific questions and they already have a relationship with the clinical provider,” said Leah Moran, MSN, nurse manager. The results have been impressive. Since program began in September, the unit’s 30-day all-cause readmission rate for heart failure has fallen by 35 percent. In fact, “we’ve had only two 7-day readmissions since starting the program.” (Continued on page 2)
KEEP YOUR EYE ON THE GOAL!
(Continued from page 1)
A similar initiative in neurosurgery has also made a positive impact on readmissions as well as after-hours calls for patients undergoing an elective procedure. As part of this program, patients received a call within two business days of discharge from either a nurse practitioner or physician’s assistant, which was documented in EPIC. Readmission rates for patients receiving follow-up phone calls were lower than those who did not receive a call, as were the number of after-hours calls received by residents.
Medication Minutes Taking the right medication at the right time and understanding why this is important are key to preventing complications and, possibly, readmissions. This is especially true for patients with complex medical needs requiring multiple medications. To help ensure that patients received the necessary information about medications, Ravdin 6 created a “medication minute” initiative. “Our goals were to help staff nurses become more confident in talking to their patients about medications as well as ensure that consistent information was being delivered,” said Joe Kluck, PharmD, the unit’s clinical pharmacist. Kluck worked with Marie Fisher, MSN, nurse manager, who facilitated the collaboration between pharmacy and nursing. Kluck initially created brief scripts focusing on the indications and side effects for the top 12 meds used on the unit. In short morning huddles with nurses, he delivered the information. Each week a new medication minute took place, gradually expanding to include
`` At the 500-day event, Jennifer McGarvey, CRNP, of Neurosurgery, described how follow-up phone calls to patients within two days of discharge helped reduce both reamissions and after-hour phone calls.
additional medications. He also emails the information to nurses on night shifts to ensure consistency. The results have been significant. Since implementating the medication minutes, the HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) scores addressing communication regarding medications demonstrated a nearly 50% improvement in the last quarter of the fiscal year 2012. “Ravdin 6 continues to aim for improved communication regarding medications and also continues to monitor how these efforts impact HCAHPS results,” Kluck said. These initiatives were just a sampling of the many efforts throughout UPHS to help reach our goal. (see sidebar at right for additional initiatives) “I thank you for all you’ve done but we cannot rest on our laurels,” Brennan said. “There’s still a great deal to do.”
SPEAKING WITH HUP’S LEADERS As a result of the recent federal sequester– the automatic across-the-board spending cuts that went into effect last month – Medicare reimbursement was cut by two percent. At last month’s Meal with An Administrator, Al Black, HUP’s chief operating officer, said that, while Penn Medicine can weather that cut, we could face additional cuts, depending on the finalized federal and state budgets for fiscal year 2014. “Health-care spending is a significant part of their budgets.” He said no cuts in health care are in the state budget at this point. However, the governor has yet to decide if the state will expand the Medicaid program to include more low-income people, an option provided by the Affordable Care Act. “We’re hoping for approval because, as part of the Act, hospitals gave up future reimbursement so that more patients could be part of the Medicaid program,” Black explained. “If the state doesn’t approve this program, people will still come to the hospital but they will not be insured.”
Black said that HUP’s year-to-date volume – both inpatient and outpatient – has been below target, which has affected our gross operating margin, as has a decrease in reimbursement in many areas. “We have a lot more work to attract more patients and continue trimming expenses.”
Preparing for the Joint Commission Visit The Joint Commission surveyors will be here some time this spring. Their findings are reported to the Centers for Medicare and Medicaid Services, which provide a “significant amount of our reimbursements. They want to know that we’re following policies and procedures and meeting their requirements for high-quality patient care.” Patient experience is an important metric as well. Andrea Mathis, Senior Employee Relations and Retention specialist in HR, advised staff to “remain calm and remember the many initiatives Penn has undertaken to improve the patient experience.”
Steps to Bring Us Closer to Our Goals
FACT is a non-profit organization cofounded by the International Society for Cellular Therapy and the American Society of Blood and Marrow Transplantation for the purpose of voluntary inspection and accreditation in the field of cellular therapy. Inspectors are leaders in the field, including Stadmauer.
Several initiatives throughout the Health System are helping us move closer to our goal of eliminating preventable readmissions and mortality, including: •C linical Decision Support: Using an Early Warning System to identify patients who are at increased risk of developing sepsis and to notify the covering provider and nurse, and nurse coordinator of a potential problem. • Primary Care Connector Nurse: Improving the discharge process for patients in the Penn Medical Home Practices, focusing on communication and patient preparedness. • PCAH-Penn E-lert Partnership: Using Penn e-lert critical care telehealth staff to monitor vital signs of Penn Care at Home patients and alerting covering physician and visiting nurse of any problems. • YORN (Your Opinion Right Now): Gathering real-time patient feedback to improve in-patient experience and increase patient engagement.
To learn more, go to the CEQI website (http://uphsxnet.uphs.upenn.edu/ceqi) and click on ‘500-day event at HUP.’
10 Years of FACT Accreditation HUP’s Stem Cell & Bone Marrow Transplant Program recently received reached its tenth year of accreditation by the Foundation for the Accreditation of Cellular Therapy (FACT), one of the first in the region to do so. These voluntary accreditations have helped make Penn’s program one of the best in the nation, said Edward Stadtmauer, MD, program director. “This process makes sure field standards are met but it’s also an intellectual learning experience. It makes us think through our processes. There are many ways to do something well … or even better.”
Two recent changes are helping to improve patient experience at HUP. “We changed our food delivery system so we can now cook meals according to the patient’s preference,” Black said. Also, HUP converted from DIRECTV to Comcast. “It may not seem major but DIRECTV doesn’t play Flyers or Phillies games,” he said. “This was a major problem when the Phillies were in the playoffs!” Three beds have been added to Ravdin 9 and two will be added on Silverstein 10. “Many days we have patients who want to come here but we have no available beds. This provides a small relief but won’t resolve the problem,” he said, adding that Penn Medicine leaders would like to eventually take down Penn Tower and build a new patient tower. But that would be many years in the future. The opening of Ground White has improved the patient experience for post-procedure patients who can’t be discharged the same day and must spend the night in the hospital. With 10 beds, this new unit significantly decreases the number of observation patients who are relegated to spend the night in the PACU.
According to Kathy Cunningham, Clinical and Quality Management coordinator, the accreditation process examines multiple services within the hospital, everything surrounding the clinical aspect, collection and processing of stem cells. This includes clinical services such as Peri-op, the OR, ED, and Pharmacy, as well as EVS and nutrition. “There’s no question: these processes have improved the outcome of patients,” Stadtmauer said. “The number of patients going into the ICU after transplant has decreased while the likelihood of coming out of the ICU to go home and live a good life has increased tremendously.” As the size of Penn’s program has increased —from 30 transplants in 1987 to about 300 a year—“having standard procedures that are validated and reviewed has become more and more important,” he continued. “The review process has led to good things. It’s a recognition of our outstanding personnel and the work that we do.”
Mathis spoke about the Tobacco-Free Hiring guidelines that will go into effect July 1, 2013. “The health and well-being of our employees matters to the organization. We offer programs, tools, benefits and resources for managing a healthy life style,” she said. “Hiring non-tobacco users promotes the overall wellness of our workforce and increases productivity of staff and projected long-term savings through our medical benefit plan. We’re creating and sustaining a healthy environment.” “We’re trying to set an example in the community,” Black added. With the many programs available to help our employees lead healthier lives, “we want to encourage people to take personal responsibility. We want to prevent illness.” Mathis also encouraged participants to participate in the ‘Take Your Child to Work’ day on Thursday, April 25. “It’s a great way to expose our future leaders to the health-care industry.”
Heartfelt Thanks I had a large tumor on my left kidney. [I was referred] to Alan Wein, MD... My visits to HUP were two/three times per week involving testing and studies to confirm a complete diagnosis… Dr. Wein performed a cystoscopy and a partial nephrectomy (removal of part of one of my kidneys...) In my 69 years of life, I have never experienced such high quality of patient care, courtesy and commitment in helping a patient cope with a seriously difficult time in his life, from the guy who valet parked your car to the receptionist, technical personnel, nurses and the doctors... Everyone I met seemed genuinely concerned about my condition, with talk of prayers, etc, all encouraging me to stay positive... I would like to thank Dr. Wein and his entire staff. They attended to me and addressed all of my medical needs with total mastery and deliberate diligence. In addition, I would like to share my post-operative experience at HUP and highlight two special nurses: Ellie Melton and Mark Durand. Both of these nurses are the essence and meaning of the profession: NURSE.
The Joint Commission will review medical records, logs, and flowsheets for certain documentation criteria, whether the entries are electronic or handwritten. To ensure that notes are easily understood: • Write legibly. Print your name under your signature if it is illegible. • Date and time all entries.
Remember: Open Enrollment is Coming Open Enrollment starts Monday, April 15, and runs through Sunday, April 28. To better understand what’s new this year, plan to attend one of the Open Enrollment fairs being held at the following locations from 10 am to 2 pm:
• Draw a single line through an error, noting date, and initial correction. Do not white out. • Use approved abbreviations. (Go to http://uphsxnet.uphs. upenn.edu/ceqi/ and click on ‘Approved Abbreviations’ on the bottom of the page, right column.) • Fill out all parts of a form. Do not leave any check-off box or section blank. • Sign each note you enter in the medical record.
• Tuesday, April 9, on the Ravdin Mezzanine • Thursday, April 11, in the Kahunatorium at 1500 Market Street
For more information go to Medical Record Entries at http://uphsxnet.uphs.upenn.edu/hupadmpl/1_12_73.pdf.
• Friday, April 12, in Suite 310 at 3001 Market Street Employees should have received an Open Enrollment booklet at their homes that will outline details. If not, contact the benefit customer service line at 215-615-2675 #4. You can also learn more at
HUPdate EDITORIAL STAFF Sally Sapega Editor and Photographer Tara Skoglund Designer
ALL EMPLOYEE MEETINGS With so much talk about health-care reform, it’s important to know its impact on Penn Medicine and how we’re preparing for it. Learn all this and more from HUP leaders at an All Employee Meeting. The next three are scheduled for: APRIL 10, FROM 8:30 TO 9:30 AM MAY 8, FROM NOON TO 1:00 PM JUNE 5, FROM 5:00 TO 6:00 PM ALL TAKE PLACE IN MEDICAL ALUMNI HALL ON 1 MALONEY.
Susan E. Phillips Senior Vice President, Public Affairs CONTACT HUPDATE AT: 3535 Market Street, Mezzanine Philadelphia, PA 19104 phone: 215.662.4488 fax: 215.349.8312 email: email@example.com HUPdate is published biweekly for HUP employees. Access HUPdate online at http://news.pennmedicine.org/inside/hupdate.