A Perfect Partnership: Ensuring a Safe Patient Transition with a Post

Discharge Firefighter Visit Linda Bauermeister BSN RN MAL, Director- Nursing and Population Health PNHS

Patti Betlach BSN RN PHN, Director- Palliative Medicine and Community Care PNHS

Steve Koering, Fire Chief - St. Louis Park

May 20, 2014

Participants:1-866-639-0744, no code needed

A Perfect Partnership:  Ensuring a Safe Patient Transition with a Post Discharge Firefighter Visit

Linda Bauermeister BSN RN MALDirector- Nursing and Population Health PNHS

Patti Betlach BSN RN PHNDirector- Palliative Medicine and Community Care PNHS

Steve Koering Fire Chief - St. Louis Park

May 20, 2014

Objectives

At the conclusion of this webinar, participants will be able to:   1.Learn how Park Nicollet Health Services partnered with the St. Louis Park Fire Department to address care transitions2.List the components of the firefighter visit3.Describe how the firefighter visit addresses the triple aim of

a. Improving Population Healthb. Improving the Experience of Carec. Improving the Affordability of Care

How our story began

• Park Nicollet has worked on patient transitions/readmissions since 2011 – RARE participant– Pioneer ACO

• Many changes have been made to the way we deliver care including– Risk stratification– Standardized care coordination/transitions/

handoffs– Post DC phone calls– Improved After Visit Summaries

Average of 49 patients go home with no services or with Home Care from Methodist Hospital / day

Fire Department approached PN• 70% of calls for SLP Fire Department are

EMS calls (about 10/day)– Many of these calls are from our patients who

have been discharged

• Opportunity to impact the pre-911 timeframe– Proactive intervention vs. reactive based on

911 call (resulting in fire, police, ambulance response)

– Reinforce discharge messages in the patient’s home setting

• Park Nicollet said YES! Let’s partner!

Lean Methodology used to Create Program• PN has used Lean Methodology since 2003

– Structured approach and tools used– Dedication to reserving resources over defined

period of time with a defined scope and targets

• Prep - 3 meetings• Kaizen Event - 4 days (day 3 we tested

visits) • Large multidisciplinary team including 4

patient partners and 7 Fire Departments from surrounding communities

Theme

To construct a process, tools, and measurement plan to pilot post

hospital discharge visits by firefighters in April

2014 that addresses all elements of the triple aim.

Targets

1. A Future state process flow including the new Post DC Hospital Visit2. Detailed process flow of the Post DC Hospital Visit.3. Identified key components of the visit.4. Identified new structures and plans - i.e. dispatch function at Methodist 5. Creation of Tools needed to complete visit 6. Measurement plan including success measures and surveys7. Training plan for pilot. 8. Completed visits on March 19 with results/suggestions for improvement9. Pilot specifics - length of pilot, pilot review plan, next steps plan

Items included in prep meetings• Sharing of information

– Background on our transitions work– Readmission information – ACO information– Firefighter training

• Addressing misconceptions• Identified who should be part of the

team• Finalized scope and targets

What we did over the 4 day event• We created what we needed to test 3

Post DC patient visits – Overall process and 4 sub processes– Visit components– Tools

• We tested 3 visits and documented our learning/issues

• We planned for the pilot including– Measures– Training

Processes

• Future state Patient Discharge flow process that includes the firefighter visit

• Four sub processes- two owned by Methodist Hospital and two owned by Fire Department– Patient ID and consent process– Dispatch process– Fire Department receipt of information process– Fire Department scheduling/pre-visit/visit process

Main components of the firefighter visit• Review of the following:

– Meds - does the patient know what medications he/she should be taking?

– Red flags - does the patient know the signs and symptoms to be aware of?

• Does the patients know who to call and when?

– Is there a follow up appointment scheduled?

• PEAT - Physical environment assessment• Connect patient with any necessary

resources

Created the tools necessary to support the process• Flyer• Opt in consent form• Firefighter visit documentation tool• Patient Survey• Many other supporting items including

– Fax sheets– Scripting– Resource sheets

Flyer

Opt in consent form

Firefighter visit documentation tool

Patient satisfaction tool

We tested three visits

Rodger reviewing the patient’s information in preparation for his call to the patient to schedule the visit

Visit learning's

• Each visit was different– One focused less on the discharge content and

more on home safety– One involved medication clarification– One was directed around marketing the

program and addressing a condition question (bruise on ankle)

• Average cycle time of visit - 17 minutes• Patient feedback was positive - patient quote:

“all of the info upon hospital discharge can be very overwhelming and it helps to clarify things in the

comfort of your own home.”

We identified issues- PN side• We have issues with the AVS-

– it’s hard to find the primary provider– The medication section is confusing

• Meds listed multiple times– A couple of AVS’ included the copy of “My

Medications” list that would be good for the refrigerator door - we found out this is not an accurate list

– The appointment section does not list reason for appointment. For example, “stress test”

• We need standard work for faxing the patient info to Fire Department along with standard fax cover letter

• We need Ziploc bags for meds not being taken

We identified issues- Fire Department side• We need to work with Dispatch

– Additional codes are needed for out of area• We need additional work on faxing process

– Tag line on fax– Need cover letter for faxes to both the fire

department and PN HIM• Would like to try folders and binder to hold

the documents• Need to review the record retention

requirements for SLP• We need a new solution to cover our feet

when entering the home. Booties don’t work

We identified issues - Fire Department side• We need job aides for

– where to get extinguishers charged, drop down ladders

– Difference between ionizing and non-ionizing smoke alarms

– Fire pits/recreational fires• We need to inform of height requirement or

provide 2 step ladder to check smoke detectors• We need criteria for a same day visit and discuss

at huddles at hospital– i.e. lives alone– No person on arrival when patient gets home

• Need list of pamphlets/other info needed - is there something on the PN website we could use?

We identified issues- both sides• Can patients who need INR’s have lab

appointment so it shows up on AVS? • We need scripting for staff/hospitalists to

market this and make sure if the patient says “yes” that the patient will be home

• We need a process for Head’s up email• We need a plan so that if firefighter is in

another city they can get a lock box key for apartments

• Can we find out if there a highlighter color that is best to use for elderly patients?

We planned for the pilot

• We will start the pilot on May 12, 2014 and include the SLP, Minneapolis, and Minnetonka fire departments

• Until then, we will do test visits every week to work out the bugs and complete other tasks so that everything is done

• A project plan has been created that includes training, communication and other pilot specifics.

Triple Aim Impact of the Firefighter Visit

Experience•Safe and success transition to home•Consistent and reinforced messages from PN team and firefighter colleagues

Experience•Safe and success transition to home•Consistent and reinforced messages from PN team and firefighter colleagues

Health•Patients have what they need to care for themselves at home and understand what to do if something changes

Health•Patients have what they need to care for themselves at home and understand what to do if something changes

Affordability•Decrease readmissions•Appropriate use of healthcare resources and decrease unnecessary 911 calls

Affordability•Decrease readmissions•Appropriate use of healthcare resources and decrease unnecessary 911 calls

Re-cap of visits from 3/17-5/1/14n=13

Our patient demographic data•Gender

– Male - 4– Female - 9

•Average age- 76 (range 25-94)•High risk- 2 documented (form updated)

Visit info - n=13

• Ave # of times called to schedule visit- 1.6

• Average cycle time of visit - 22 minutes

• Appointment times - 9:30 AM to 1:30 PM

Visit info - outcomes of visit

Patient Feedback- n=6

• I felt Methodist Hospital staff informed me about the firefighter visit in a way that I could understand - 100% strongly agree

• The firefighter arrived within the arranged time frame - 100% strongly agree

• The firefighter visit gave me confidence in managing my medications– 33% strongly agree– 50% agree– 17% disagree – 0% strongly disagree

Patient Feedback - n=6• Please rank the following four aspects of your

firefighter visit according to what was most helpful to you - average ranking below– Understanding medications - 3.2 – Who to call with questions - 1.8 – Understanding your follow-up appointments - 2 – Home Safety Survey - 3

• I would recommend a firefighter visit to my family and friends – 71% strongly agree– 29% agree– 0% disagree– 0% strongly disagree

Patient Feedback - n=6

• Comments– The firefighters could have been a little

“warmer” in their communication. They seemed more “businessy.”

– Great Program!– Especially for those patients not receiving a

home care visit/follow-up, I feel this program could be very beneficial. All the info upon hospital discharge can be very overwhelming and it helps to clarify things in the comfort of your own home.

– I think they did a good job!– Fantastic job - well worth it

Areas still requiring work

Patient hospitalized at

Methodist Hospital

Discharge planning

completed and reviewed with

patient including Firefighter visit

Patient discharged to home.

Firefighter visit scheduled. Information

handoff to home care or clinic.

Firefighter visits with patient and documentation

completed

Home Care visit done or Patient goes to clinic for Hospital DC Visit

Future State- Patient Discharge Flow

DC phone call to patient 24-72 hours post DC

ID patients and Opt in process?

Pre-visit planning

What to document and how to transfer info to PN

Scheduling process with SLP FD

Escalation process to additional resources

Other items:1. Plan Pilot2. Billing and Accounting3. Fire Department- redistribution of workload during peak periods. Scheduling considerations if major event4. Testing the visits during KE5. Communication6. Education/Training7. Data/Reporting8. Address political issues9. Visit standards for statewide use10. Credentialing11. What vehicle to show up in. 12. Marketing needs

Patient given survey form to

complete and send back to PN.

Incomplete Visits- patient cancellations

Getting patients to consent

Questions?

Upcoming RARE Events….

RARE Action Learning Day and Reception June 17, 2014 (8:30 a.m. – 3:30 p.m.)Crown Plaza Hotel - Plymouth, MN

Registration now open!

Thank You…

This is the final webinar for the RARE

Campaign!

To view past webinars visit,

www.rarereadmissions.org