Hospital to Home: Keeping our patients safe IHS Leadership Symposium Breakout Session I April 20, 2010 Peg M. Bradke, RN, MA St. Luke’s Hospital, Cedar.

Hospital to Home:Hospital to Home:Keeping our patients safeKeeping our patients safe

IHS Leadership SymposiumIHS Leadership Symposium

Breakout Session I Breakout Session I April 20, 2010April 20, 2010

Peg M. Bradke, RN, MAPeg M. Bradke, RN, MASt. Luke’s Hospital, Cedar Rapids, IowaSt. Luke’s Hospital, Cedar Rapids, Iowa

Who Owns the Transition?

Are we placing the burden on the patient?

What is causing the readmissions? Do we know?

Are we being proactive?

Reducing Re-Hospitalizations: Background

If re-hospitalizations are prevalent, costly, and able to be reduced, why haven’t they been?

Hospital-level barriers Financial disincentives (volume-revenue), no financial incentives,

not part of P4P contracts, not high on priority list, limited disease-specific efforts

Community-level barriers Not common to engage organizations across continuum to

collaborate on improving care, frustration between inpatient and post-acute providers, lack of IT connectivity, no reimbursement for coordination

State-level barriers Lack of population-based data, lack of understanding costs of poor

quality on systems, effect of fragmented payer market and lack of CMS participation

Need for Paradigm Shift

Traditional focus on discharging patients > facilitating transitions in care and a shift to handoffs (senders and receivers design the process)

Hospital Problem to Continuum issue Focus on what clinicians are teaching > to focus on what

the patient is learning Patient is the focus of the care team > patient and

defined family are essential members of the care team Immediate focus on clinical needs > to a focus on the

whole person and their social situation over time Focus on patient care needs in various settings > focus

on the patient’s experience over time

Transition to Home Team

Heart Failure team since 2001 St. Luke’s joined the Institute for Health Care

Improvement (IHI) Innovation Project for Transitions to Home in February 2006

Work concentrated on the Heart Failure patient to provide the “ideal” transition to home

Goal: To Improve the reliability of the care patients receive and resultant outcomes

Worked in tandem with compliance to CMS Core Measures

St. Luke’s Heart Failure Continuum

Standardized care through order sets Teaching

Utilizing Universal Health Literacy Concepts Enhanced teaching materials Teach back

Touchpoints Home Care - care coordination visit 24 to 48 hours post

discharge Follow-up physician clinic visit appointment in three to

five days APN - follow-up phone call on seventh day post

discharge Outpatient Heart Failure class Collaboration with cardiology office Heart Failure Clinic

What Changes Can We MakeThat Will Result in Improvement?

Key Changes to Achieve an Ideal Transition

from Hospital to Home:

1. Perform an Enhanced Assessment of Post-Hospital Needs

2. Provide Effective Teaching and Facilitate Learning

3. Provide Real-time Patient and Family-Centered Handoff Communications

4. Ensure Post-Hospital Care Follow-Up

How-to Guide: Creating an Ideal Transition Home -- Page 6

Creating an Ideal Transition HomeI. Perform Enhanced Admission Assessment for Post-Hospital NeedsA. Include family caregivers and community providers as full partners in completing

standardized assessments, planning discharge, and predicting home-going needs.B. Reconcile medications upon admission.C. Initiate a standard plan of care based on the results of the assessment.

II. Provide Effective Teaching and Enhanced LearningA. Identify all learners on admission.B. Customize the patient education process for patients, family caregivers, and providers

in community settings. C. Use “Teach Back” daily in the hospital and during follow-up phone calls to assess the

patient’s and family caregivers’ understanding of discharge instructions and ability to perform self-care.

III. Conduct Real-Time Patient and Family-Centered Handoff CommunicationA. Reconcile medications at discharge.B. Provide customized, real-time critical information to the next care provider(s).

IV. Ensure Post-Hospital Care Follow-UpA. High-risk patients: Prior to discharge, schedule a face-to-face follow-up visit (home care

visit, care coordination visit, or physician office visit) to occur within 48 hours after discharge.

B. Moderate-risk patients: Prior to discharge, schedule a follow-up phone call within 48 hours and schedule a physician office visit within five days.

Although the care that Although the care that prevents rehospitalization prevents rehospitalization occurs largely outside the occurs largely outside the

hospital, it starts in the hospital, it starts in the hospital. hospital.

Steve Jencks, Steve Jencks, NEJMNEJM 2009 260:1417-28 2009 260:1417-28

Enhanced Admission Assessment for Post-Discharge Needs

Identify the appropriate family caregivers Partner with home care agencies, primary care offices

and clinics, and long-term care facilities Initiate a standard plan of care based on the results of

the assessment Designate a person accountable for the effective

discharge of each patient Estimate the home-going date on admission and

anticipate needs Key learner may be different than Care Provider

Who is managing medications? Who do you want to be included in your discharge

instructions?

Emphasis on Cross Continuum Team/Interdisciplinary Team

These views added new context to ourefforts.

• Home Care representative• Family member of a HF patient• Long-Term Care representative• Physician Clinic representative• Patient

Facilitating Patient-Centered Care

“Nothing about me without me” Patient and family needs and goals for the

day associated with going home are listed on the white board

Consider what it would be like to be a patient going home

Care Plan Partner – if they are included, they will be engaged; include in rounds, shift handoffs, and all discharge preparation discussions

The richest source of The richest source of information is under our information is under our

nosenose……

The PatientThe Patient

Interventions to Enhance Assessment for Post-Discharge Needs

Take 5 Daily discharge huddle Bedside reporting

All opportunities to review plan for day and anticipate discharge needs

Identify Opportunities:Chart Review Tool

Known reason(s) for readmission. What did the patient or family think contributed to the

readmission? Any self-care instructions misunderstood? Evidence of teach back documented? Was a follow-up physician visit scheduled? Attended? Number of days between the discharge and physician’s

office visit. Number of days between discharge and readmission

Any urgent clinic/ED visits before readmission? Was discharge plan clear?

Functional status of patient on discharge

Interview Questions

For patients with HF that are readmitted within 30 days of lastadmission: Can you tell me in your own words why you think you ended up sick

enough to be readmitted again?

Can you tell me what a typical meal has been for you since you left the hospital? What did you have for dinner last night?

Where are your scale and calendar located?

Have you seen your doctor since you were discharged from the hospital?

Do you have all of your medications? How do you set your pills up every day?

Were there any appointments that kept you from taking any of your pills?

17

How-to Guide: Creating an Ideal Transition Home --






III. Conduct Real-Time Patient and Family-Centered Handoff CommunicationA.Reconcile medications at discharge.B.Provide customized, real-time critical information to the next care provider(s).




19

Intervention:Patient Education Material

Key “small tests of change” Reviewed content of educational

materials utilizing health literacy concepts

Outpatient Heart Failure class utilized as focus group for content

Family member on team, along with her siblings, reviewed content for understanding Health Literacy

Paradigm ShiftParadigm Shift

““The patient is noncompliant”The patient is noncompliant”

vs.vs.

Asking: What is our responsibility as the Asking: What is our responsibility as the sender of the information?sender of the information?

Health LiteracyHealth Literacy

““If they don’t do what we If they don’t do what we want, we haven’t given want, we haven’t given them the right information.”them the right information.”

Vice Admiral Richard Carmona, Former Surgeon GeneralVice Admiral Richard Carmona, Former Surgeon General

22

Redesign Patient Teaching Materials

During acute care hospitalizations for HF, only essential education is recommendedReinforce within one to two weeks

after dischargeContinue for three to six months

Adams, KF et al: HFSA 2006 Comprehensive Heart Failure Practice Guideline. Journal of Cardiac Failure Vol. 12, No. 1, pg 61 February 2006

http://www.heartfailureguideline.org/document/hfsa_2006_comprehensive_heart_failure_guidelines.pdf

23

Universal Communication Principles

Focus on key points Need to know vs. nice to know Emphasize what patient should do Avoid duplicating paperwork Be careful with color

24

Keys to Success with Health Literacy

Use universal health literacy communication principles to redesign written teaching materials

User-friendly written materials use: Simple words (1-2 syllables) Short sentences (4-6 words) Short paragraphs (2-3 sentences) No medical jargon Two-word explanations, e.g., “water pill/ blood

pressure pill”

Add more white space Highlight or circle key information Headings and bullet points Increase font size Remove ranges On all written material, assure words/

terminology match Use visual aids Provide a health context for numbers or

values

Keys to Success with Health Literacy

Heart Failure Magnet

Heart Failure Zones

28

Heart Failure

Heart failure means your heart is not pumping well. Symptoms of heart failure may develop over weeks or months. Your heart becomes weaker over time and not able to pump the amount of blood your body needs. Over time your heart may enlarge or get bigger.

Your heart When you have heart failure, it does not mean that your heart has stopped beating. Your heart keeps working, but it can’t keep up with what your body needs for blood and oxygen. Your heart is not able to pump as forcefully or as hard as it should to move the blood to all parts of your body. Heart failure can get worse if it is not treated. Do what your doctor tells you to do. Make healthy choices to feel better.

Changes that can happen when you have heart failure

Blood backs up in your veins Your body holds on to extra fluid Fluid builds up, causing swelling

in feet, ankles, legs or stomach This build up is called edema

Fluid builds up in your lungs This is called congestion

Your body does not get enough blood, food or oxygen

Signs of heart failure

Shortness of breath Weight gain from fluid build up Swelling in feet, ankles, legs or

stomach

Feeling more tired. No energy Dry hacky cough It’s harder for you to breathe

when lying down

Some causes of heart failure

Heart attack damage to your heart muscle

Blockages in the heart’s arteries which doesn’t let enough blood flow to the heart

High blood pressure

Heart valve problems Cardiomyopathy Infection of the heart or heart

valves

Ejection Fraction One measurement your doctor may use to see how well your heart is working

is called ejection fraction or EF The ejection fraction (EF) is the amount of blood your heart pumps with each

heart beat The normal EF of the pumping heart is 50% to 60% Heart failure may happen if the EF is less than 40%

Treatment for heart failure Eat less salt and salty type foods Take medicines to strengthen your heart and water pills to help your body

get rid of extra fluid Balance your activity with rest. Be as active as you can each day, but take rest periods also Do not smoke

Medicines you might take Diuretic “water pills”- these help your body get rid of extra fluid Beta blocker- lowers blood pressure, slows your heart rate Ace Inhibitor-decreases the work for your heart, lowers blood pressure Digoxin-helps your heart pump better

Things for you to do to feel better each day Follow the guidelines on the St. Luke’s Heart Failure Zone paper Check yourself each day-Which heart failure zone are you today? Watch for warning signs and symptoms, call your doctor if you are in the

yellow zone. Catch the signs early, rather than late Do not eat foods high in salt Do what your doctor tells you to

To learn more about heart failure Attend St. Luke’s FREE heart failure class Phone (319) 369-7736 for more information Visit the following web sites

www.americanheart.org American Heart Association www.abouthf.org Heart Failure Society of America www.heartfailure.org Heart Failure Online

Adapted from American Heart Association 7/2006

31

Online Discharge Instructions

St Luke’s Hospital, Cedar Rapids, Iowa

32

Evaluation of New Patient Education Material

Results from 15 follow-up phone calls:“Information very helpful.”Able to state where information was

and reported that they were referring to it.

Understood content.


33

Evaluation of New Patient Education Material

Successfully answered teach back questions related to “water pill,” diet and weight.

Improvement opportunity – patients were often unclear when they had multiple physicians which one to call for the symptoms (magnet revised).


34

Assess Patient Recall &ComprehensionAsk Patient toDemonstrate

Clarify & TailorExplanation

Re-assess Recall &Comprehension

Ask Patient to Demonstrate

Explain / DemonstrateNew Concept

Patient Recalls andComprehends/

Demonstrates Mastery

Adherence/Error Reduction

NEW CONCEPT:Health Information,

Advice, Instructions orChange in Management

Arch Intern Med, 2003;163:83-90 Copyright © 2003, American Medical Association. All Rights reserved

Closing the Loop

Check points to evaluate how well transactions are going

How well we are doing giving the information

How often do we close the loop?

37

Enhanced Teaching and Learning

Utilizing “Teach Back” Explain needed information to the patient

or family caregiver. You do not want your patient to view

TeachBack as a test, but rather of how well you explained the concept. You can place the responsibility on yourself.

Can be both a diagnostic and teaching tool

38


Ask in a non-shaming way for the individual to explain in his or her own words what was understood

Example: “I want to be sure that I did a good job of teaching you today about how to stay safe after you go home. Could you please tell me in your own words the reasons you should call the doctor?”

39


Redesign patient teaching: Stop and check for understanding using

Teach Back after teaching each segment of the information

If there is a gap, review again If your patient is not able to repeat the

information accurately, try to re-phrase the information rather than just repeat it. Then, ask the patient to repeat again until you fee comfortable that the patient understood.

40

Redesign Patient Teaching

Slow down when speaking to the patient and family and break messages into short statements

Take a pause Be an active listener Use plain language, breaking content into short

statements Segment education to allow for mastery

41

Teach Back Questions

What is the name of your water pill?

What weight gain should you report to your doctor?

What foods should you avoid?

Do you know what symptoms to report to your doctor?


42

Enhance Teaching and Facilitate Learning Use Teach Back daily: • In the hospital • During home visits and follow-up phone calls • To assess the patient’s and family caregivers’

understanding of discharge instructions and ability to do self-care

• To close understanding gaps between:• Caregivers and patients • Professional caregivers and family

caregivers

43

Teach Back Competency Validation


Nursing Competency Assessment

Annual competency validation day Methodology

The learning station will use discussion, role playing and patient teaching scenarios to help RN’s communicate effectively to patient/family.

How-to Guide: Creating an Ideal Transition Home










Opportunities for ImprovementOpportunities for Improvement

81% of patients requiring assistance with 81% of patients requiring assistance with basic functional needs failed to have a basic functional needs failed to have a home care referral home care referral

64% said no one at the hospital talked to 64% said no one at the hospital talked to them about managing their care at homethem about managing their care at home

Clark PA. Patient Satisfaction and Discharge Process: Evidence-Based Best Practice. Clark PA. Patient Satisfaction and Discharge Process: Evidence-Based Best Practice. Marblehead, MA: HCPro, Inc., 2006Marblehead, MA: HCPro, Inc., 2006

Patients sometimes do not see Patients sometimes do not see readmissions as a failurereadmissions as a failure

Reconcile Medications for Discharge

Communicate clearly to the patient, family caregiver and next care team:

Names of each medication, reason to take it New medications and pre-hospital

medications the patient is to discontinue Whether there are any recommended

changes in the dose or frequency from pre-hospital instructions

47

Pre-hospital medications to be continued with the same instructions

Medications and over-the-counter medications that should not be taken

The cost of the medication Can patients read their medication

labels, afford the necessary medications and food, and get to the pharmacy?

48

Reconcile Medications for Discharge

Patients going home: Provide patient and family

Easy-to-read self-care instructionsWhat to expect at homeMedication card with current medicationsReasons to call for help Numbers for emergent needs and non-

emergent questions

49

Real-Time Patient and Family-Centered Handoff Communication

Patients going home: Identify the appropriate care providers (physicians, home

care, other providers) Transmit critical information at time of discharge Ideally precedes or accompanies patient to next care

location Be sure the information adequately delineates patient status

and recommendations for plan of care Speak with emergency contact listed in medical record

before discharge and provide critical information on patient safety

50


Example of Calendar

51


Patients going to community facility: Alert next care providers to patient’s discharge

readiness and needs post discharge Nursing home or SNF liaison with hospital Ask receiving care teams for their preferred

format, mode of communication and specific information needs about patient’s functional status.

Share patient education materials and educational processes across all care settings

Long-Term Care/Skilled Nursing Facility

• Patient education is sent with all nursing home patients at discharge.

• Educational offerings for the staff conducted in the LTC/SNF

• Long-term care/Skilled Nursing Facility representative added to our HF Team.


Schade et al; Impact of a national campaign on Schade et al; Impact of a national campaign on hospital readmission in home care patient; hospital readmission in home care patient; JournalJournal

of Quality Health Careof Quality Health Care vol 21, no 3 vol 21, no 3

Hospitalization rates appeared to improve Hospitalization rates appeared to improve in agencies participating in the National in agencies participating in the National Campaign compared with those not Campaign compared with those not participating.participating.

Use of the material was significantly more Use of the material was significantly more common among agencies whose common among agencies whose performance improved. performance improved.

Home Health Quality Initiative National Campaign Intervention Used

Hospitalization risk assessment Patient emergency plan Phone monitoring and loading visits Teletriage Medication management Telemonitoring Immunization Physician relationships Fall prevention Patient self-management/disease management Transitional care coordination

Mor et al; The Revolving Door of Mor et al; The Revolving Door of Rehospitalization from Skilled Nursing Rehospitalization from Skilled Nursing

Facilities, Facilities, Health AffairsHealth Affairs Jan. 2010 29:1Jan. 2010 29:1

Almost one-fourth of Medicare beneficiaries Almost one-fourth of Medicare beneficiaries discharged from the hospital to a skilled nursing discharged from the hospital to a skilled nursing facility were readmitted to the hospital within facility were readmitted to the hospital within thirty days; this cost Medicare $4.34 billion in thirty days; this cost Medicare $4.34 billion in 2006. 2006.

The overall rate increased from 18.2% in 2000 to The overall rate increased from 18.2% in 2000 to more that 23.5% in 2006. more that 23.5% in 2006.

Case Management MonthlyCase Management MonthlyReducing Hospital-SNF 30-day ReadmissionReducing Hospital-SNF 30-day Readmission

(2007 Pfizer)(2007 Pfizer)

Finding from 931 hospitals and SNF Finding from 931 hospitals and SNF interviews in 2009 indicated that 30-day interviews in 2009 indicated that 30-day hospital readmission could be reduced if:hospital readmission could be reduced if: SNF had better access to hospital staffSNF had better access to hospital staff

and documentationand documentation Medication changes for non-medical Medication changes for non-medical

or formulary reasons were minimized as or formulary reasons were minimized as patients transition between settingspatients transition between settings

Which Setting is Most Responsible for Readmission in 30 Days?

Hospital View

1. Patient

2. SNF

3. Physician Practice

4. Hospitals

5. Government

6. All of above

7. None of above

SNF View

1. Hospitals

2. Patients

3. Physician Practice

4. SNF

5. Government

6. All of above

7. None of above

Barriers to Efficient Transitions

The two settings agree that better communication and better education management, including support for discharge planners, are highly likely to reduce readmissions Yet, less than 9% of Hospitals and 14% of

SNF’s reported regular meetings or hold multiple facility transition of care meetings to discuss cases or processes.

Establish Cross-Venue or Continuum Collaboration Develop creative solutions for bi-

directional communication and feedback processes, coordination and greater understanding of patient needs

Continually improve by aggregating the experience of patients, families, and caregivers and designing improvements

61

How-to Guide: Creating an Ideal Transition Home -- Page 6










Post Acute Follow-Up

High-Risk Patients Patient has been admitted two or more times in

the past year Patient failed “Teach Back” or the patient or

family caregiver has a low degree of confidence to carry out self-care at home Patient and family caregiver have the phone

number for questions and concerns Consider home care or discharge coach

Identifying High Risk

History of rehospitalization Failed teach back Longer stay than expected High-risk conditions Poor, disabled, or on dialysis But, the resources used in screening

might be better spent on system changes

Post Acute Follow-Up

Moderate risk patients: Patient has been admitted once in the past

year Patient or family caregiver has moderate

degree of confidence to carry out self-care at home Prior to discharge, schedule follow-up phone

call within 48 hours Schedule a physician office visit within five

days

Controlled TrialsControlled Trials

Clinic visit only is not enoughClinic visit only is not enough Nursing support alone is equivalent to Nursing support alone is equivalent to

telemonitoringtelemonitoring Early follow-up appointment important, but Early follow-up appointment important, but

not clear if it is 3-5-7 days; some data not clear if it is 3-5-7 days; some data show after seven days is too longshow after seven days is too long

Multidisciplinary team most effective Multidisciplinary team most effective Single home visit can make a differenceSingle home visit can make a difference

Intervention: Dietitian Visits

Mandatory on all patients

Intervention: Home Care Visit24-48 Hours Post Discharge

Small test of change October 2006 Education to all Home Care staff Visit 24-48 hours after discharge Visit outline

Medication Reconciliation Review of diet and foods in-house Teach back on water pill, diet and weight Vital signs Hardwired process in January 2007

Intervention: Nursing Home

Patient education sent with all nursing home patients at discharge.

Educational offerings for the staff conducted in the nursing homes.

Nursing home representative added to our HF Team.

Intervention: Primary CareFollow-Up Appointment

Worked with Primary Care to assure follow-up visits scheduled three to five days post discharge

Particularly on high-risk patient for readmission

Intervention: Follow-Up Phone Call

Advance Practice Nurse makes follow-up phone call at seven days post-discharge

Standardize questions Results monitored and changes made as

needed based on feedback Results monitored globally and per

individual unit

Data Speaks: Evaluating Data Speaks: Evaluating Progress in Reducing Heart Progress in Reducing Heart

Failure ReadmissionsFailure Readmissions

Facility Assessment

Is reducing Readmission a strategic priority for Executive Leaders?

What is you understanding of the problem? Have you established improvement goals? What will help you drive the Success in the

Improvement process? What and how are you providing oversight? What investments are we willing to make What are you measuring?

Measurement

How will we know

change is an improvement?

Outcome Measures: Readmission

Measure Name Description Numerator Denominator

30-Day All-Cause Readmissions

Percent of discharges with readmission for any cause within 30 days

Number of discharges with readmission for any cause within 30 days of discharge Exclusion: planned readmissions (e.g., chemotherapy schedule)

The number of discharges in the measurement month Exclusions: transfers to another acute care hospital, patients who die before discharge

30-Day All-Cause Readmissions for Chronic Conditions such as heart failure and COPD

Percent of discharges with heart failure, COPD, etc., who were readmitted for any cause within 30 days of discharge

Number of discharges with heart failure or other chronic conditions readmitted for any cause within 30 days of discharge Exclusion: planned readmissions (e.g., chemotherapy schedule)

Number of discharges in the measurement period with heart failure or other chronic conditions Exclusions: transfers to another acute care hospital, patients who die before discharge

Harvard Public Health Harvard Public Health Literacy Literacy

Finding that current efforts to collect and Finding that current efforts to collect and publicly reported data on discharge publicly reported data on discharge planning are unlikely to yield large planning are unlikely to yield large reductions in unnecessary readmissions.reductions in unnecessary readmissions.

Jha, NEJM 361:27 Dec. 2009Jha, NEJM 361:27 Dec. 2009

Attending MD During Hospitalization(Nov 07 – Dec 09)

60%18%

22%

Cardiology Hospitalist PCP

Discharge Status (Nov 07- Dec 09)

52%

27%

12%

9%

Comp Visit VNA/Other Referral Refused Missed

302724211815129630-3-6

12

10

8

6

4

2

0

Number of Days Between Admissions

Frequency

Mean 10.36StDev 8.389N 56

Normal Histogram of Days Between Admissions (with Outlier removed)

Palliative Care Referral•Year-to-date, 10% referred to Palliative Care•In 2007, averaged less than 5%

26%

15% 15%

27%

16%

13%

19%

15%

3%

0%

15.2%14.6%

20%

16.7%

20%18.5%

31.3%

14.8%

30.4%

18.8%

21.4%

0%

5%

10%

15%

20%

25%

30%

35%

Apr-0

8M

ay Jun

Jul

Aug Sep OctNov Dec

Jan-0

9Feb M

ar AprM

ay Jun

Jul

Aug Sep OctNov Dec

Successful Teachback Rate

65%

70%

75%

80%

85%

90%

95%

100%

Aug

06

Nov Fe

b

May Au

g

Nov Fe

b

May Au

g

Nov Fe

b

May Au

g

Nov

APN VNA In Hospital

70%

75%

80%

85%

90%

95%

100%Au

g 06

Nov

Feb

07

May

-

Aug-

07

Nov

-

Feb-

08

May

-

Aug-

08

Nov

-

Feb

May Au

g

Nov

Patient Satisfaction on Discharge Handoff

“I had a great time tonight and I’d like to see you again in four to six weeks.”

3-5 Day Follow-up

6% 6% 6% 4% 4%

19%17%19%

42%

84%

68%

81%

64%

45%

51.9%

69.4%66.7%

73.9%

40.0%

72.2%

66.7%

57.9%

88.2%

50%

88.9%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Nov-07

Dec

Jan-

08 Feb Mar Apr

May Ju

nJu

lAug

Sep OctNov

Dec

Jan-

09 Feb Mar Apr

May Ju

nJu

lAug

Sep OctNov

Dec

I @:@ -1 : - f, I I .

'And this is the period when the cat was away. '

Percent of Heart Failure Patients Readmittedwithin 30 Days with Heart Failure

Good

(Numerator based on discharge date; denominator is number of discharges excluding deaths.)

0%

5%

10%

15%

20%

25%

30%

35%J

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Percent Median Linear (Percent)

Percent of Heart Failure Patients Readmittedwithin 30 Days for Any Cause

Good

(Numerator based on discharge date; denominator is number of discharges excluding deaths.)

0%

10%

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40%

50%

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Percent Median Linear (Percent)

Peg BradkePeg BradkeSt. Luke’s Hospital St. Luke’s Hospital Cedar Rapids IowaCedar Rapids Iowa

[email protected]@crstlukes.com

COPD/Pneumonia

What would your teachback questions be?

What are the vital few?

Hospital to Home: Keeping our patients safe IHS Leadership Symposium Breakout Session I April 20, 2010 Peg M. Bradke, RN, MA St. Luke’s Hospital, Cedar.

Documents

care patients

patient care needs

care team patient

care teamimmediate focus

heart failure patient

lukes hospital

standard plan of care

traditional focus