Leader Rounding. Does It Impact Outcomes?

Leader Rounding. Does It Impact Outcomes?

Sherry Sweek, RHIA, CPHQ, CPMSM, Director, Quality Improvement

Southeast Georgia Health [email protected], 912.466.3265

September 26, 2012

Southeast Georgia Health System

• Two hospitals: Brunswick-316 beds, Camden-40 beds

• Two Nursing Homes: Brunswick-232 beds, St. Marys-78 beds

• Physician Practices: over 79 physicians in primary care and specialty care

• 2,200 team members

• Focus today is experience at Camden facility

Session Learning Objectives

1. Discuss how to incorporate Leader Rounding into practice.

2. Outline the steps to implement a successful Leader Rounding program.

3. Identify the outcomes impacted by Leader Rounding.

P D C A (Plan, Do, Check, Act)Quality Improvement Model

• PLAN-How should the problem be tackled? Address issues surrounding problem.

• DO-Implementation of the plan.

• CHECK-How will the team know the plan is working? What data must be collected? Test.

• ACT-How to best go forward? Redesign? Evaluation Step.

Plan the Improvement• HCAHPS scores unfavorably decreased in

August 2011 and based on drop negatively impacted 2011 YTD scores – Maternity HCAHPS-90th percentile– Med/Surg HCAHPS drive overall Camden HCAHPS

• Approached VP and Assistant Administration at Camden to gain support for addressing solution in September 2011

• Situation discussed at October 2011 Camden Patient Care & Safety Committee (oversight for quality at operations level) with managers from clinical and non-clinical areas

Do the Improvement

• Developed standardized process (who, what, where, when) for rounding on Med/Surg floor

• Presented at next Leadership meeting with forms

• Folder on shared drive (access by all leaders) with forms and calendar for leaders to self-schedule

• Leaders agreed to pilot for three months and measure improvement

Leader Rounding PilotWho: Patients admitted within last day and

those scheduled for discharge next day

What: Rounding using standard Rounding Form and

follow-up on issues identified & turn in form to

Admin Sec

When: Leader to pick two days in Month (Mon-Fri)

Where: Med/Surg

When: You may round anytime but morning may be

better so if there are concerns you still have

an opportunity to address same day

Leader Rounding Early Wins

• Supplement to bedside nurse hourly rounding and nurse manager rounding

• Admin Rounding (VP, Assistant Administrator, Quality Director) discussed Leader Rounding with team members and the early outcomes

• Pulled HCAHPS based on discharge date to see if scores improved

• Camden Leaders seen as early adopters and setting the standard for System rounding

Check Leader Rounding Pilot ResultsMed/Surg Unit Jan-Sep

11Nov 11-Jan 12

Rate the hospital 9-10 63% 69%

Recommend this hospital 69% 74%

Communication with Nurses 67% 77%

Response of hospital staff 54% 61%

Communication with Doctors 81% 82%

Room and bathroom kept clean 70% 85%

Area around room quiet at night 55% 62%

Pain management 64% 65%

Communication on medications 55% 62%

Discharge information 81% 89%

Check Other Results • Feedback:

– Leaders enjoyed rounding and felt they were making a different

– Patients appreciated someone coming to visit

• The interventions prevented problems from becoming larger issues

• Leaders could re-enforce patient safety topics (fall prevention, calling for assistance, isolation precautions)

Act on Results • Leaders agreed to continue Leader Rounding• Determined measures to track outcomes• Set 2012 HCAHPS goals to improve into next

quartile rankings• HCAHPS indicators (Communication with

Nurses, Response of Hospital Staff) shared at Nursing leadership meetings comparing all units throughout System

• Participate in GHA Hospital Engagement Network to impact patient outcomes

2012 Leader Rounding• Service Excellence Coordinator rounds every

Wednesday and meets with managers to resolve issues and address concerns

• Safety huddles to address core measure compliance, patient concerns, infections, issues identified)

• Leader Rounding expanded to Brunswick Campus in April 2012 based on positive experience at Camden

YTD 2012: No injury falls Inpt. Injury Falls Per 1000 Inpt. Days

Camden Campus

0.0

0

1.4

0

0.0

0

1.6

1

0.0

0

0.0

0

1.6

8

1.3

9

0.0

0

0.0

0

2.7

1

3.0

1

0.0

0

0.0

0

0.0

0

0.0

0

0.0

0

0.0

0

0.0

0

0.0

0

0.0

1.0

2.0

3.0

4.0

5.0

Month-Year

# o

f In

pt

Inju

ry

Fa

lls/

10

00

In

pt

Fa

lls

Inpt. Injury Falls Per 1000 Inpt. Days

6 Month Rolling Average

Benchmark

12 Month Rolling Average

Med/Surg: Formal Compliances & Grievances

12

8

0

5

10

15

20

2011 Annualized2012

Nu

mb

er o

f C

om

pla

ints

Core Measures 2012 results

Composite Score(# of interventions completed/# of interventions applicable to patient)

2011 Jan-Jun 2012

US Top Quartile

Heart Attack 100.0% No pts 99.7%

Heart Failure 85.9% 84.0% 98.4%

Pneumonia 92.0% 88.7% 97.6%

Surgical Care 98.2% 98.0% 98.4%

US top quartile based on hospital compare data for time frame Q4/10-Q3/11 on whynotthebest.org

Red 0-25th percentile

Yellow 26th-50th percentile

Green 51st-75th percentile

Blue 76th-100th percentile

Pneumococcal VaccinationJan-12:Pneumo Immunizations expanded to high risk patients

90.90% 91.30% 94.70% 100.00% 100.00% 93.30%

0.00%

20.00%

40.00%

60.00%

80.00%

100.00%

Jan-12 Feb Mar Apr May Jun

2012 Core Measures Misses• Physician

Impact: 83%

• Nurse Impact: 17%

NA2

8.6

%

28

.6%4

2.9

%

0.0%

20.0%

40.0%

60.0%

80.0%

100.0%

PN HF SCIP AMI

% o

f va

ria

nce

s

Other 2012 Outcomes• Zero hospital acquired conditions

– Foreign object retained after surgery*– Air embolism*– Blood incompatibility*– Pressure Ulcer stage III or IV*– Falls & trauma– Vascular catheter-associated infection*– Catheter-associated Urinary Tract Infection*– Manifestations of poor glycemic control

• Zero patient safety indicators– Death among surgical inpatients with serious treatable complications– Latrogenic pneumothorax– Post-Op PE or Deep Vein Thrombosis– Postop wound dehiscence– Accidental puncture or laceration

Questions?

Questions: Sherry Sweek, 466-3265 or [email protected]