Leader Rounding. Does It Impact Outcomes?

1. Leader Rounding. Does It Impact Outcomes? Sherry Sweek, RHIA, CPHQ, CPMSM, Director, Quality Improvement Southeast Georgia Health System ssweek@sghs.org, 912.466.3265 September 26, 2012

2. 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

3. Session Learning Objectives • Discuss how to incorporate Leader Rounding into practice. • Outline the steps to implement a successful Leader Rounding program. • Identify the outcomes impacted by Leader Rounding.

4. 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.

5. 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

6. 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

7. Who: 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 Pilot

8. 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

9. Check Leader Rounding Pilot Results

10. 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)

11. 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

12. 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

13. YTD 2012: No injury falls

14. Med/Surg: Formal Compliances & Grievances

15. Core Measures 2012 results US top quartile based on hospital compare data for time frame Q4/10-Q3/11 on whynotthebest.org

16. Pneumococcal Vaccination Jan-12:Pneumo Immunizations expanded to high risk patients

17. 2012 Core Measures Misses • Physician Impact: 83% • Nurse Impact: 17%

18. 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

19. Questions? Questions: Sherry Sweek, 466-3265 or ssweek@sghs.org