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PATIENT READMISSION: Home visits help post-discharge

Adult patients discharged from hospitals in the Cleveland Clinic Health System who were thought to be at high risk of readmission were studied. These patients were offered different combination of home visits made by advanced practice nurses and/or paramedics. No significant difference was found with 90-day readmissions, 180-day readmissions, emergency visits or patient mortality, but the 30-day readmission rate was lower in the study group compared to a matched group that did not receive the home visits.

Source: Anita D. Misra-Hebert, and others. “Healthcare utilization and patient and provider experience with a home visit program for patients discharged from the hospital at high risk for readmission.” Healthcare 9(1) (Mar. 2021). Full text free here: https://www.sciencedirect.com/science/article/pii/S2213076420301172

AMBULATORY CARE: How time of day affects quality of care and what to do about decision fatigue

Quality of care deteriorates over the course of the day due to the combination of shared cognitive biases, hurried visits, and mounting decision fatigue…”

Studies show that the quality of outpatient care decreases over the course of the clinic day. Patients seen later in the day are likely to have fewer appropriate services ordered and, also, more low-value inappropriate services ordered. A difference in diagnostic accuracy has also been found based on time of day. How to counteract this time-of-day trend by incorporating alerts into the electronic health record, by using social norm interventions, by optimizing use of telehealth and mail, and by changing payment models are discussed.

Source: Allison H. Oakes, and Mitesh S. Patel. “Time to Address Disparities in Care by Appointment Time.” Healthcare 9(1), (Mar. 2021). https://www.sciencedirect.com/science/article/pii/S2213076420301068

ORGANIZATIONAL INNOVATION: McKinsey consultants forecast what pandemic-driven change will look like

Business leaders tell us that the metabolic rate of their organizations has soared. Their companies have accelerated by adopting new ways to work.”

How much and in what ways will the pandemic push companies to adopt Silicon Valley-inspired nimble organizational concepts? What will the agile operational model look like in the near term? McKinsey thought leaders focus on change accelerations brought on by the pandemic and how things are changing more quickly than had been thought possible. A key set of three steps should be employed: to reflect, decide and then deploy at scale. Learnings from the pandemic will help organizations position themselves for greater uncertainty in the future.

Jost, Gregor, and others. “How COVID-19 is redefining the next-normal operating model.” The McKinsey Quarterly 1 (2021). Full text free here: https://www.mckinsey.com/business-functions/organization/our-insights/how-covid-19-is-redefining-the-next-normal-operating-model

PARKINSON’S: Integrated practice unit (IPU) offers one-stop-shop model of care

The concept of an integrated practice unit (IPU) would offer patients with the same disease – Parkinson’s is explored in this article but the model has broader applicability – a team of specialists with appropriate resources at hand for the care of a complex chronic condition.  Several case examples of providers who are developing this type of care include:

  • ParkinsonNet in The Netherlands
  • Kaiser Permanente
  • Van Andel Research Institute (Grand Rapids, MI) – based on the ParkinsonNet model
  • Cleveland Clinic

The author identifies two components as critical for an IPU: patient-reported outcome measures and focus on value.

Sources: McKee, K. (2019, August 1). Creating “one-stop shop” care for Parkinson’s. NEJM Catalyst. Click here: https://catalyst.nejm.org/one-stop-shop-care-parkinsons/

Kaiser Permanente. Our care model.  Click here:  https://parkinsonscare.kaiserpermanente.org/our-care-model/

Van Andel Institute and ParkinsonNet explore partnership. (2015, June 2). News Release.  Click here: http://www.parkinsonnet.info/news/van-andel-institute-and-parkinsonnet-explore-partnership

Porter, M.E., Teisberg, E.O. (2019, June). Cleveland Clinic: Transformation and growth 2015. HBS Case Collection. Click here:  https://www.hbs.edu/faculty/Pages/item.aspx?num=36929  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

 

CULTURE: How to use guiding coalitions to change organizational culture

How to change hospital culture through the use of a quality collaborative approach was explored in this research study of 10 hospitals that are part of the Mayo Clinic Care NetworkThe project centered on reducing mortality for heart attack patients but the findings shed light on how to effect culture change within organizations generally, even beyond health care provider settings.  The authors examine what worked and what didn’t in the culture change project.  Here are some of their findings as to what is important:

  • Having diverse representation on the guiding coalition
  • Fostering an environment of “discovery, learning and teaching” among guiding coalition members
  • Learning how to manage conflict and how to sustain engagement

Of the 10 hospitals studied, 6 were found to have made significant positive shifts in organizational culture.

Source: Bradley, E.H., Brewster, A.L., McNatt, Z., and others. (2017, November 3). How guiding coalitions promote positive culture change in hospitals: A longitudinal mixed methods interventional study. BMJ Quality & Safety. Click here open access free full text: http://qualitysafety.bmj.com/content/early/2017/11/02/bmjqs-2017-006574.long  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

ANTIMICROBIAL STEWARDSHIP: Staffing ratio for hospitals

The recommendation for staffing of a comprehensive antimicrobial stewardship program in a hospital setting was developed based on a study done in 12 Veterans Health Administration hospitals.  The recommended staffing guideline is:

  • 1 FTE pharmacist per 100 occupied beds

Source: Echevarria, K., and others. (2017, November). Development and application of an objective staffing calculator for antimicrobial stewardship programs in the Veterans Administration. American Journal of Health-System Pharmacy. 74(21), 1785-1790. Click here for publisher’s website: http://www.ajhp.org/content/74/21/1785.long  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

SURGICAL SUITE: Implementing ERAS at Kaiser Permanente

Engagement among patients and clinicians is excellent, and the ERAS team is working toward realizing the vision of enhanced recovery hospitals where the ERAS paradigm becomes the standard of care for the 190,000 adult inpatients hospitalized in KPNC each year.”

How Kaiser Permanente Northern California implemented an Enhanced Recovery After Surgery (ERAS) project in 20 KPNC medical centers is described in this lengthy, scholarly article.  The initiative began with colon surgery patients, but success in reducing inpatient length of stay and post-op complication rates has led to expansion of the ERAS model to other surgical patients.  This article is well illustrated with graphics which will be helpful to other providers working through similar implementation projects, including a sample “My Calendar: Recover Safely and Quickly” intended for colon surgery patients.

Source: Liu, V.X., and others. (2017, Summer). The Kaiser Permanente Northern California enhanced recovery after surgery program: Design, development, and implementation. The Permanente Journal, 21(3), 53-61.  Click here: http://www.thepermanentejournal.org/issues/2017/summer/6477-the-kaiser-permanente-northern-california.html  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

NICUs: What is a small baby unit?

Small baby units take the neonatal intensive care unit (NICU) concept to a new level by specializing in the care of the smallest babies – known as micro-preemies – born at fewer than 27 weeks gestation and/or weighing less than 1,000 grams (2.2 pounds).  The design of the units, which are part of a larger NICU, includes providing a dark, quiet environment.  Parents are encouraged to participate in skin-to-skin care (SSC) techniques that fosters bonding, such as Kangaroo Mother Care.  Caregivers are teamed up to deliver two-person care when the micro-preemies need to be touched.  As the babies grow, they may be transitioned out of the small baby unit to the NICU.

Hospitals with Small Baby Units (this is not a comprehensive list)

  • Advocate Lutheran General Hospital (Park Ridge, IL)
  • Children’s Hospital (Orange, CA)
  • Greenville Health System (Greenville, SC)
  • Helen Devos Children’s Hospital (Grand Rapids, MI)
  • Mercyhealth Hospital-Rockton Avenue (Rockford, IL)
  • Nationwide Children’s Hospital (Columbus, OH)

Sources:

Gonya, J., and others. (2017). Investigating skin-to-skin care patterns with extremely preterm infants in the NICU and their effect on early cognitive and communication performance: A retrospective cohort study. BMJ Open, 7.  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5372108/pdf/bmjopen-2016-012985.pdf

GHS launches NICU small baby unit. (2017, May 12). WSPA-TV. http://wspa.com/2017/05/12/ghs-launches-nicu-small-baby-unit/

Jackson, A. (2015, December 9).  Born at 25 weeks weighing less than 2 pounds, ‘spunky’ girl survives in small baby unit. MLive. http://www.mlive.com/news/grand-rapids/index.ssf/2015/12/small_baby_nicu_at_devos_child.html

Morris, M., Cleary, P., and Soliman, A. (2015, October). Small baby unit improves quality and outcomes in extremely low birth weight infants. Pediatrics, 136(4).  http://pediatrics.aappublications.org/content/pediatrics/136/4/e1007.full.pdf

Watley, K. (2017, February 6). Mercyhealth in Rockford opens region’s first small baby unit to care for micro-preemies. https://mercyhealthsystem.org/mercyhealth-opens-small-baby-unit-rockford/

Woloshyn, E. (2017, April 20). Special unit mimics mother’s womb. Health enews.

http://www.ahchealthenews.com/2017/04/20/special-unit-mimics-mothers-womb/  Posted by AHA Resource Center (312) 422-2050 rc@aha.org

BEST PRACTICES: Implementing a quality improvement bundle for care of high risk infants in the delivery room

This was a case study of 548 high-risk infants born 2010 to 2012 at Palomar Medical Center (Escondido, CA) who were then transferred to the neonatal intensive care unit at Palomar Rady Children’s Hospital (San Diego).  About half of the infants were born before implementation of an quality improvement project intended to standardize delivery room management – a preintervention group.  The merits of each of the changes in practice – such as a significant decrease in intubation – are discussed.  A delivery room checklist is included.

Source: Sauer, C.W., and others. (2016, November 16). Delivery room quality improvement project improved compliance with best practices for a community NICU. Scientific Reports, 6, 37397.  Click here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5116615/pdf/srep37397.pdf  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

BENCHMARKS: Space planning in labor and delivery

This is a rule-of-thumb provided by Hayward & Associates, a health care facility planning firm, that may be used to plan for a labor and delivery area.  In the following ratios, LDR means labor-delivery-recovery.  LDRP means the same except adds a postpartum stay in the same room – this is also known as single-room maternity care.

Space planning based on annual births

  • 100 to 200 births / LDRP room if the LDRP concept is used exclusively
  • 300 to 400 births / LDR or LDRP room if some patients are moved to a separate postpartum room after discharge

Recommended departmental gross square feet (DGSF) and departmental gross square meters (DGSM) are also given in this brief article.

Source: Hayward, C. (2017, Spring-Summer). Obstetrical services capacity and preliminary space need. SpaceMed Newsletter. Click here: https://www.spacemed.com/newsletter/rule-102-ob.pdf  Posted by AHA Resource Center (312) 422-2050, rc@aha.org