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Project RED Re-Engineering Discharge. Faculty from Joint Commission Resources Deborah M. Nadzam, PhD, BB, FAAN Susan Whitehurst, MSN, MBB. Project RED: Module 1. Preparation for the redesign of your discharge process. Re-engineering Discharge.

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project red re engineering discharge

Project REDRe-Engineering Discharge

Faculty from Joint Commission Resources

Deborah M. Nadzam, PhD, BB, FAAN

Susan Whitehurst, MSN, MBB

project red module 1

Project RED: Module 1

Preparation for the redesign of your discharge process

re engineering discharge
Re-engineering Discharge
  • The goal of the AHRQ- funded project is to help participating hospitals across the country improve the discharge process to assist patients more safely care for themselves at home and to prevent readmissions
module i outline
Module I Outline
  • Course Overview Modules 1-4
  • Planning your project
  • Project RED components
discharge planning
Discharge Planning

Discharge Order Written

H & P

Rx Plan

Patient Admission

Discharge Event

Discharge Process

PATIENT EDUCATION

DISCHARGE INSTRUCTIONS

Post-D/C Follow-up

module 1 getting started objectives
Module 1: Getting Started!Objectives
  • Identify organizational strategic priorities that will align with local, regional and national requirements
  • Develop a systematic performance improvement process to facilitate knowledge transfer and sustainable change
  • Review the roles of executive sponsor, project team leader, discharge advocate, physician champion and pharmacist in the redesigned discharge process
  • Develop an understanding of Project RED’s 11 components
course overview modules 1 4
Course Overview Modules 1- 4
  • Module 1 – Getting Started!
  • Module 2 – Patient Admission

Care and Treatment

  • Module 3 – Patient Discharge and Follow Up Care
  • Module 4 - The Hospital Launch
slide8

Principles of the Newly Re-Engineered Hospital Discharge

Explicit delineation of roles and responsibilities

Discharge process initiation upon admission

Patient education throughout hospitalization

Timely accurate information flow:

From PCP ► Among Hospital team ► Back to PCP

Complete patient discharge summary prior to discharge

slide9

Principles of the Newly Re-Engineered Hospital Discharge

(continued)

Comprehensive written discharge plan provided to patient prior to discharge

Discharge information in patient’s language and literacy level

Reinforcement of plan with patient after discharge

Availability of case management staffoutside of limited daytime hours

Continuous quality improvement of discharge processes

performance improvement structure
Performance Improvement Structure

Deming, Shewhart, Lean

Lean Six Sigma

DEFINE

MEASURE

ANALYZE

IMPROVE

CONTROL

  • PLAN
  • DO
  • CHECK (STUDY)
  • ACT
determine your infrastructure
Determine Your Infrastructure

OversightCommittee

Champions

Project Teams

project red oversight steering committee
Project RED Oversight “Steering” Committee

Vision

Mandate Improvement

Identify Champions

Receive and Review Updates

selecting the right projects
Selecting the Right Projects

Aligned to core hospital-wide strategies

Standardized project metrics will roll up to organization’s balanced scorecard

Contain a manageable scope

Address customer and stakeholder needs

Create sustainable improvement

emphasize process focus on results
Emphasize Process, Focus on Results
  • What really matters to the organization? – achieve bottom line results
  • Can we measure the impact of the project?
  • How much has the project contributed this year and will contribute in future years?
project champion
Project Champion

Communicates the Vision

Selects Project & Scope

Selects Candidates for Training

Reviews Projects Weekly

Removes Barriers and Supplies Resources

project team leader
Project Team Leader
  • Becomes educated in PI tools
  • Is a competent and confident facilitator
  • Is objective and neutral to the process
  • Facilitates an organized plan for the team
  • Is results focused
project physician champion
Project Physician Champion
  • Communicates with Senior leaders
  • Communicates with Medical Staff
  • Provides physician perspective to the project team
  • Assists in the elimination of system barriers
  • For Project RED – believes in the intervention and value of improving discharge program
discharge advocate
Discharge Advocate
  • Designed to oversee patient discharge preparation
  • Coordinates all discharge activities within patient population
  • Facilitates team activities and discharge planning rounds with primary MD
  • Collects discharge focused data
  • Assures completion of AHCP and demonstrated learning by the patient
discharge advocate da
Discharge Advocate (DA)
  • Is notified when patients in target population are admitted/diagnosed
  • Initiates action steps associated with Project RED
  • Initiates Patient Care Plan
  • Educates patient and family about condition, medications , other treatments, post discharge plans, and follow up ordered by the physician
  • Reviews Patient Care Plan with patient and family
  • Collects measurement data specific to project and patient population
patient s physician
Patient’s Physician
  • Initiates patient plan of care based on critical pathway
  • Leads and/or participates in discharge planning rounds
  • Communicates potential date of discharge
  • Supports the performance improvement process
pharmacist
Pharmacist
  • Verify physician orders
  • Reconcile admission meds with meds from home
  • Collaborate with care team specific to discharge needs
  • Reconcile meds upon discharge
  • Assist with patient medication questions
as a team consider the following questions
As a team, consider the following questions:
  • Is our project scope manageable?
  • Do we have PI structure including oversight steering committee, project champion, DA, Pharmacist, team members , team leader, scheduled dates, times and resources needed for the meetings?
  • Have we alerted ad hoc resources such as finance, medical records, IT, education dept, etc as needed?
  • What is missing and who will be responsible?
develop the team project charter
Develop the Team Project Charter
  • Establish team members
  • Identify key stakeholders
  • Determine the problem statement
  • Determine the AIM statement (mission)
  • Identify patient and organizational benefits
  • Establish project targets and milestones
  • Acquire senior leadership sanctioning
define your current state
Define your current state:
  • Initiate a high level process map
  • Multidisciplinary participation
  • Patient admission is the starting point
  • After hospital care provision is the ending point
  • Ask each discipline what steps they take to prepare the patient for discharge
once the process map is completed
Once the process map is completed…
  • Analyze the work flow in the eyes of the patient
  • What defects exist? Where are communication breakdowns, failure to hand off information?
  • Where do the delays occur?
  • What are your Project RED gaps?
  • Do we have omission , selection, documentation, communication, administration failures?
  • What steps in this process would

our patient be willing to “pay for”?

establish your gap analysis
Establish your Gap Analysis

Sample Current State Process

Project RED components

Med Reconciliation

National guideline used

Follow up Appointment

Outstanding Tests

Post DC services

Written DC Care Plan

Emergency Contact

Patient Education

Demonstrated Learning

DC Summary to PCP

Post DC Phone Call

  • Discharge order
  • Discharge Instruction Form
  • Discharge teaching on day of discharge
  • No Discharge Advocate
  • No appt scheduled
  • No post DC phone call
  • No PCP DC Summary
metrics to assess impact
Metrics to Assess Impact
  • Timeliness of Project RED activities
  • Completion of patient care plan (thoroughness)
  • Outcomes
    • Readmission rates
    • Patient satisfaction with preparation for discharge
    • Staff satisfaction
    • Cost
team activities
Team Activities:
  • Discuss high level process map comparison
  • Determine when you will draw/redraw your high level map
  • What failures are you predicting?
  • What measurements do you have in place?
red checklist
RED Checklist

Eleven mutually reinforcing components:

1. Medication reconciliation

2. Reconcile discharge plan with national guidelines

3. Follow-up appointments

4. Outstanding tests

5. Post-discharge services

6. Written discharge plan

7. What to do if problem arises

8. Patient education

9. Assess patient understanding

10. Discharge summary sent to PCP

11. Telephone reinforcement

Adopted by

National Quality Forum

as one of 30 US

"Safe Practices" (SP-15)

11 red components enable discharge advocates to
11 RED Components Enable Discharge Advocates to:

Prepare patients for hospital discharge

Help patients safely transition from hospital to home

Promote patient self-health management

Support patients after discharge through follow-up phone call

generating the patient care plan
Generating the Patient Care Plan
  • “Manual” – use of template for discharge advocate (DA) to enter all required data
  • Provide template to your IT department and request that they integrate with existing systems
  • May wish to or have already purchased discharge planning software which is integrated with your existing systems
ahrq template for care plan
AHRQ Template for Care Plan
  • Free, downloadable, fill-able PDF form
  • Based on Project RED After-Hospital Care Plan
  • Store on your server for easy access by D.A.
  • Integrate with your current systems as able
  • Hard copies available from AHRQ

www.ahrq.gov/qual/goinghomeguide.htm

slide41

A Visual: After Hospital CarePlanhttp://www.bu.edu/fammed/projectred/toolkit.html

compare discharge information
Compare Discharge Information

LIST CURRENT STATE

Patient Care Plan Sections

Individual hard copy care plan (language specific)

Medication calendars in lay terms

Daily morning, afternoon and evening meds identified

Patient questions list

Scheduled follow up appointments

Pending tests and results

Location of appointments

  • Patient Name/Diagnosis
  • List of DC medications
  • Review of prescriptions
  • Dietary recommendations
  • Activity limitations
  • Post DC appointment if known

WHAT ARE WE MISSING?

eliminate documentation time and re writes
Eliminate Documentation Time and Re-writes

Ideally, information should flow from the medical record to the care provider that needs it.

Ideally, information should flow from one practice setting to another

Ideally, information that is documented can be time stamped and assessed for accuracy

Ideally, the Patient Care Plan could be automated and flow to the hands of the care team and patient

communication and coordination with the pcp
Communication and Coordination with the PCP

The hospital discharge process is often characterized by poor communication and a lack of coordination between the hospital and the PCP. 

When patients are discharged, they often do not know what medications their physicians have prescribed, when their follow up appointments should take place, and, in some cases, why they were hospitalized in the first place.

primary care physician referral base
Primary Care Physician Referral Base

Leaders will identify the PCP referral base

PCP satisfaction will be assessed prior to project launch

Physician champion will communicate with PCPs about project

PCPs will advise how to handle their off shift and weekend patient needs

LEADERSHIP PRIORITY!

the post discharge phone call
The Post Discharge Phone Call
  • Define who will call your patient after discharge
  • Define when the follow up call will be made
  • Develop script for caller
  • Remember to develop the process for off shifts and weekends
module 1 summary expected outcomes
Module 1: SummaryExpected Outcomes
  • Develop your infrastructure that will promote communication, understanding of team progress, and documentation of the Patient Care Plan
  • Review the roles of executive sponsor, project team leader, discharge advocate, physician champion and pharmacist in the redesigned discharge process
  • Develop a systematic performance improvement process that will facilitate knowledge transfer and sustainable change
  • Embed Project RED key principles, including application of the patient care plan, communication with PCPs and implementing post DC phone calls
progression to module ii checklist
Progression to Module II Checklist
  • Current State Process Map ___
  • Primary Physician Referral Base ___
  • Patient Care Plan Structure ___
  • Project Charter Initiated ___
  • Dates for training frontline staff set ___
  • Team evaluation of Module 1 ___
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