working toward decreased readmissions in the pediatric gi population holly bernal, rn, msn, np,...
TRANSCRIPT
![Page 1: Working Toward Decreased Readmissions in the Pediatric GI Population Holly Bernal, RN, MSN, NP, IBCLC Mary L. Johnson Ambulatory Care Center Pediatric](https://reader038.vdocument.in/reader038/viewer/2022110321/56649ceb5503460f949b6c8e/html5/thumbnails/1.jpg)
Working Toward Decreased Readmissionsin the Pediatric GI Population
Holly Bernal, RN, MSN, NP, IBCLCMary L. Johnson Ambulatory Care Center
Pediatric GastroenterologyClinic Coordinator
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The PICO QuestionWould pediatric GI multidisciplinary team members, after implementation of education of the Ohio Children’s Hospital for Patient Safety recommendations on readmissions have improved knowledge related to readmissions?
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The Aim• To look at reasons for readmission and repeat clinic appointments for
pediatric gastroenterology patients
• To improve understanding of the Ohio Project Bundle on readmissions and how we can use that in the clinic setting
• To make recommendations that could improve patient care, decrease readmissions and unnecessary repeat clinic appointments
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Background
• Educating the residents on preventable readmissions proved beneficial. 98% of those who attended the multidisciplinary readmissions meeting felt more involved in trying to improve the readmission rate compared to 40% of those who did not attend the meeting. Njeim et al. (2012)
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Background
• Factors contributing to potentially preventable readmissions included care during the stay (57%), the discharge process (67%) and follow up care (79%). Figenbaum et al. (2012)
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• In a study of 782 adult patients with heart failure, 68% of the patients that received all their discharge instructions were significantly less likely to be readmitted for any cause (p = 0.003) and for heart failure (p=0.035) than those who did not receive complete discharge instruction. VanSuch et al. (2006)
Background
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Current Practice
• Patients are scheduled based on the providers determination for follow up and if the patient calls asking to be seen.
• There is no current protocol at LPCH for decreasing readmissions, but LPCH is implementing the Ohio Children’s Hospital Bundle for Readmissions
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The Ohio Project Bundle• The Ohio Project is a collaborative of hospitals dedicated to improving patient safety based on JCAHO recommendations.
• The Readmission Bundle consists of:– Identify high-risk patients – those that are most likely to
be readmitted.– Review every readmission and determine preventability
– what can we do different to keep these kids home.– Provide feedback to clinicians on readmit rate – Standardize the discharge process
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Small Test of Change• Pre and Post Surveys assessing knowledge
• 23 pre -surveys with 14 returned (61%)
• Educational program consisting of:– hand-outs – Huddles– information posted in clinic and our division office.
• I sent out 14 post-surveys and got 8 back (57%)
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RESULTS
Pre Survey Post Survey0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1
Question 1Question 2Question 3
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Repeat Visits to Clinic• Retrospective Chart Review for Clinic Visits in Jan 2013
• Clinic visits scheduled: 520• Actual patients seen: 364• No shows: 46 (9%)• Cancel/Reschedules: 137 (26%)• Number of repeat visits: 26 (5%)
• Note: Our no show rate will increase as now we are marking all cancels/reschedules that happen day of clinic as no shows.
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Hospital Readmissions
Nov 2012 – Jan 2013
Total admissions for GI48
Total readmissions for GI 17 (35 %)
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Challenges and Rewards
• The pre-survey was well received and received enough responses to go forward with my project.
• Getting on the agenda at our Monday meeting was a challenge and this put me behind about a week.
• Getting post-surveys returned was very difficult and affected my results
• After all was said and done I said a big thank you to my team for their participation and support.
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Next Steps• Recommendations:
– increase the use of the outpatient RN with the inpatient population and
– work toward standardized discharge teaching for those kids going home with specialized feeds and injections.
• Further Evidenced-Based work looking at whether standardized discharge teaching decreases readmissions.
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REFERENCESBerry, MD., J & et al. (2013). Pediatric Readmission Prevalence and Variability Across
Hospitals. JAMA, 309(4), 372-380.
Bisset, A.F. (1998). The case for clinical audit of emergency readmissions after appendicetomy. The Royal College of Surgeons of Edinburgh, 43; 257-261.
Feignenbaum, MD, P., & et al, (2012). Factors contributing to all-cause 30-day readmissions: a structured case series across 18 hospitals. Medical Care, 50(7),
599-605.
Gay, J.C., & et al. (2011). Epidemiology of 15-Day Readmissions to a Children’s Hospital. Pediatrics, 127(6); 1505-1512. Retrieved from Pediatrics.aappublications.org
Hain, P.D., & et al. (2013). Preventability of Early Readmissions at a Children’s Hospital. Pediatrics, 131(1); 171-182. Retrieved from Pediatrics.aappublications.org
Halfon, MD., P. & et al. (2006). Validation of the Potentially Avoidable Hospital Readmission Rate as a Routine Indicator of the Quality of Hospital Care. Medical
Care 44(11); 972-981
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REFERENCESMugford, M., Banfield, P., & O’Hanlon, M. (1991). Effects of feedback of information
on clinical practice: a review. BMJ 303; 398-402.
Njeim, MD, M & et al. (2012). System-Based Approach to Educating Internal Medicine Residents on Preventable Hospital Readmissions. Journal of Graduate
Medical Education, 505-509. Retrieved from dx.doi.org
Perez, F.D., & et al. (2013). Characteristics and Direct Costs of Academic Pediatric Subspecialty Outpatient No-Show Events. Journal for Healthcare Quality,
pp.1- 11.
Stevens, et al. (2007). A qualitative examination of changing practice in Canadian neonatal intensive care units. Journal of Evaluation in Clinical Practice, 13;
287- 294.
VanSuch, M., & et al, (2006). Effect of discharge instructions on readmissions of hospitalised patients with heart failure: do all of the joint commission on accreditation of healthcare organizations heart failure core measures
reflect better care?. Qual Saf Health Care, 15(414), Retrieved from www.qshc.com
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Thank you!
• My cohorts: Maggie Church, RN, BSN
Karen Hartley, RN, BSN• My mentors: Annette Nasr, RN, PhD.
Linda Ikuta, RN, MSN
Kari Ksar, PNP, MSN
Amy Fisher, RN, MSN