Outcomes Report 2015, Lieberman Center for Health and Rehabilitation

Lieberman Center for Health & Rehabilitation 2015 Outcomes Report (January 2015-December 2015)

9700 Gross Point Rd. | Skokie, IL 60076 847-929-3320 www.cje.net

Contents

Introduction .................................................................................................. 3 Lieberman Center for Health & Rehabilitation ............................................. 3 Physician Specialists at Lieberman Center .................................................... 3 Transitional Care Nursing Program ............................................................... 4 Short-Term Rehabilitation Outcomes ........................................................... 5 Rehospitalization Rates ................................................................................ 6 Satisfaction Survey Results ........................................................................... 7 Infection ....................................................................................................... 7 House-Acquired/Nosocomial Infections ....................................................... 7 House-acquired/Nosocomial Urinary Tract Infections .................................. 8 Multi-Drug Resistant Organisms ................................................................... 8 House-Acquired Pressure Ulcers................................................................... 9

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Introduction We are pleased to present the following Outcomes Report for Lieberman Center for Health and Rehabilitation (LCHR). This report for 2015 consists of outcomes directly related to patient care.

Lieberman Center’s Short-Term Rehabilitation Services Lieberman Center’s Sub-Acute Unit offers these short-term rehabilitation services with specialized staff: skilled rehabilitation therapy; a dedicated Center for Heart Health; skilled nursing, including, but not limited to, hemodialysis, peritoneal dialysis, infusion therapy and wound care. The staff consists of the following: specially trained RNs; a seven-day-a-week nurse practitioner; a transitional care nurse; physical, occupational and speech therapists; and social services staff. There are credentialed medical consultants who round weekly or see patients more often, depending upon need. The consultant medical staff consists of the following specialties: cardiology, nephrology, pulmonology, physiatry, wound care, infectious disease, psychiatry, and neuropsychology. Coordination of care and communication among all disciplines on the Unit is managed by the Clinical Nurse Manager, who is Masters-prepared and has had extensive clinical experience, including wound care, telemetry, organ transplant aftercare, respiratory therapy (i.e. tracheotomies and ventilators). She has extensive managerial and teaching experience also.

Physician Specialists at Lieberman Center Cardiology Dr. Caesar DeLeo is a member of the Cardiology Division at NorthShore University HealthSystem. He has spent his career helping patients with heart failure. He is board-certified in Cardiology and Internal Medicine and received his medical training at the University of Florence School of Medicine and Surgery in Florence, Italy. After internships there and at Weiss Memorial Hospital in Chicago, he completed his residency at Weiss, and received further Fellowship training at University of Illinois at Chicago Medical Center.

Nephrology Dr. George Kim is a board certified Nephrologist. He is supported by the NorthShore University Medical Group Department of Nephrology. His expertise and our personalized clinical services allow for optimal care and outcomes.

Pulmonology Dr. Maher Najjar is board-certified in Internal and Pulmonary Medicine. He completed his training at Cook County’s Stroger Hospital and Mercy Hospital. He is affiliated with several hospitals.

Physiatry Dr.Jason Gruss received his undergraduate degree from the University of Michigan and his medical degree from Chicago Medical School/Rosalind Franklin University. He completed his residency in Physical Medicine and Rehabilitation at Schwab Rehabilitation Hospital. Dr. Gruss is a Physiatrist, and 3

is Board Certified in Physical Medicine and Rehabilitation. His areas of interest are Geriatric Rehabilitation and Musculoskeletal Medicine.

Wound Care Dr. Jeffrey Rager received his D.P.M. from the Scholl College of Podiatric Medicine and completed his residency at Rush University Medical Center. He is board-certified in Foot Surgery by the American Board of Podiatric Surgery. Dr. Rager currently maintains his practice as President of North Shore Foot and Ankle Center. He specializes in the treatment and prevention of foot and ankle wounds.

VOHRA Wound Care Physicians make rounds and provide treatment on a weekly and on an as needed basis. Physicians caring for wounds may come from several different disciplines including general surgery, vascular surgery, podiatry and dermatology, among others. Other medical specialists such as plastic surgeons may become involved in patient care, depending upon the origin, location and extent of the wound. These physicians attain certification through the American Academy of Wound Management to become a Certified Wound Specialist Physician (CWSP) as well as their specific disciplinary specialty.

Transitional Care Nursing Program In the latter part of 2014, Lieberman Center instituted a Transitional Care Nursing Program. This Program was implemented and is managed by a Transitional Care Nurse (TCN) who is a Registered Nurse who has extensive experience in Home Care as well as clinical care in the hospital setting. The Program complements the work of the Social Service workers on the unit by assessing and addressing the clinical aspects of patients’ needs as they relate to discharge. The TCN provides additional education regarding post-discharge care and medication, follows up with the patient’s primary care physician (PCP) in the community and makes a follow up well-being call. She also coordinates efforts with the PCP’s Nurse Practitioners and Physician Assistants to enhance the quality and communication for follow up care after discharge. On average the TCN spends a minimum of eight hours with each patient during the discharge process. The addition of this Program to the discharge process is intended to promote the goals of increased success post-discharge by the patient and family, thus improving the patient’s well-being. This impact on reducing rehospitalizations is a major goal of the program. The following statistics reflect the Program’s activities.

Transitional Care Nursing 2015 100% 80% 60% 40% 20% 0%

100% 85%

95%

1st Quarter

100% 100% 94%

2nd Quarter

100%

100% 85%

3rd Quarter

94% 96%100%

4th Quarter

99%

90%

99%

Annual

% With follow-up PCP Appointment Made Within 7 Days of Discharge % With PCP Appt. Made Who Kept Appointment % With Documented Hand Off to PCP

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Short-Term Rehabilitation Outcomes The Therapy Department works primarily on a patient’s functional status. Efforts are directed at increasing strength, endurance, and balance. The three areas that are measured are transferring/ toileting; dressing; and ambulation. Data is then used to determine a patient’s overall outcomes for improvement in functional ability from their admission status to their status at the time of discharge.

(See Legend)

Score on Care Tool Scale

2015 Lieberman Center Overall Outcomes for Short-Term Rehabilitation 6 5

4

4 3 2

3 2

3

4

3

3

2

4 3

1 1st Quarter

2nd Quarter

Avg. Overall at Admit

3rd Quarter

4th Quarter

Annual

Avg. Overall at Discharge

KEY TO CARE TOOL SCALE

6=Complete Independence (No assistance required) 5= Set Up (Helper sets up or cleans up. Patient is able to complete task alone.)

4= Supervision-Minimal Assist (Helper provides verbal cues or touching/steadying assistance as patient completes task.

Help may be provided throughout the task or intermittently.)

3= Moderate Assist (Helper lifts, holds, or supports trunk or limbs but provides less than half the effort to complete task.)

2= Maximum Assist (Helper lifts, holds, or supports trunk or limbs and provides more than half the effort to complete task.)

1= Total Assist (Helper provides all of the effort to complete task.

Note: This Scale is a standardized functional measurement tool with a scale of 1 to 6, where 1 is the most dependent and 6 is independent. The first data point is determined by the therapist at time of the initial assessment, which is performed within 24 hours of admission to Lieberman Center. The second data point is determined by the therapist at time of discharge. The average overall improved functional ability was 1 point on this scale

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Rehospitalization Rates There are several points that should be noted regarding the rates in the following chart. The number of patients for those which represent primary diagnoses was very small in each quarter. The statistical significance, therefore, is not valid. In addition, none of the rates are risk adjusted.

2015 30-Day Rehospitalization Rates 100% 80% 60% 40% 20%

50% 20% 23% 18%17% 19% 0%

0% All Patients ** Primary Admitting Diagnosis

8% 10%

17% 15%

33% 33%29%30% 27% 22% 25%

0% 0% 0% 0% 0%

All Orthopedic**

2nd Quarter

23% 23% 13%

13% 0%

Pneumonia** 1st Quarter

21% 17%

Total Joint Replacement**

3rd Quarter

Cardiac**

4th Quarter

Congestive Heart Failure**

Annual

A chart with the rates for a comorbidity of patients with End Stage Renal Disease (ESRD) requiring dialysis were included to demonstrate the major impact that the risk of comorbidities and their associated conditions have on the incidence of rehospitalizations.

All Diagnoses with the Comorbidity of End Stage Renal Disease requiring Dialysis 100%

90%

91%

80%

58%

60%

43%

40% 20%

6%

0% 1st Quarter

2nd Quarter

3rd Quarter

4th Quarter

Annual

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Satisfaction Survey Results Customer Satisfaction Surveys are conducted on a regular basis. They utilize a tool that was developed by an independent analytics company. The company analyzes the results and submits a report to Lieberman Center on a regular basis.

Satisfaction Survey for Lieberman Center 2015 100.0% 90.0%

86.6% 88.1%

90.3% 91.4%

92.8% 91.0%

87.0% 88.2%

89.2% 89.7%

1st Quarter

2nd Quarter

3rd Quarter

4th Quarter

Annual

80.0% Overall Satisfaction with Care & Services Likeliness to Recommend to Friends or Family

Infection Surveillance Data The safety, recovery, and well-being of patients are easily threatened by the occurrence of an infection. It is, therefore, of prime importance to have a sound infection surveillance program in place for the provision of quality care.

House-Acquired/Nosocomial Infections The first chart contains the rates for the incidence of all house-acquired infections. Note that the infection rates are all higher in the first quarter of the year when colds and flu are prevalent. In the second quarter a higher rate was identified for Lieberman Center. Upon further investigation it was discovered that there was need for education of staff regarding the discernment of correctly determining the site where the infection was acquired. A number of times an infection that was present on admission had been counted as being acquired at Lieberman Center.

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Rate per 1000 Patient Days

2015 Nosocomial Infection Incidence Rates 8

6 7

6

5

5 5

6

5 3 3

4

3 3

4 4

4

5

2 0 1st Quarter 2nd Quarter House

3rd Quarter

LTC

4th Quarter

Annual

Short-Term Rehab

House-acquired/Nosocomial Urinary Tract Infections (UTI)

Rate per 1000 Patient Days

The second chart shows the rates for house acquired urinary tract infections (UTIs). This rate is monitored since urinary tract infections are the most common in this setting and are often seen after a hospitalization. Of greatest importance to note is that none of the UTIs were associated with urinary catheter usage.

2015 Nosocomial UTI Incidence Rates

4 3 2

3

3

3

2

2

2 2

2 1

1

1 1

1 0 1st Quarter

2nd Quarter House

LTC

3rd Quarter

4th Quarter

Short-Term Rehab

Multi-Drug Resistant Organisms The third chart reflects the prevalence of multidrug resistant organisms (MDROs). An important aspect of knowing the prevalence of MDROs is that it reflects the effectiveness of the implementation of the control and management of existing infections. One can see that the rates are highest in Lieberman Center. This is due to the fact that patients are being admitted with infections caused by multi-drug resistant organisms. During a hospitalization with an acute illness, many are quite compromised and susceptible to infection. This frequently necessitates being treated with a number of antibiotics, which increases the likelihood of the development of a multi-drug resistant organism. The very low rates on the long term care floors are reflective of the effective management of these infections.

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Rate per 1000 Patient Days

2015 Multi-Drug Resistant Organisms (VRE. MRSA, ESBL, C-Diff, CRE) Prevalence Rates Period used = 1 month 4

4 3 2 1 0

0 0

1

1

1st Quarter

0

0 0 0

2nd Quarter

3rd Quarter

House

LTC

0 0

1

4th Quarter

2

0 0

Annual

Short-Term Rehab

House-Acquired Pressure Ulcers

Rate Per 1000 Patient Days

Lieberman’s skin management program includes protocols for prevention, treatment, and pain assessment and management. The nursing staff is augmented by a board certified podiatric surgeon and a wound specialty surgeon, who make weekly rounds and are active members of the wound management team. Additional specialties are involved in the care when needed. It is Lieberman’s practice to count each pressure ulcer rather than each resident who has one or more pressure ulcers.

This is a considerably more stringent method of data collection, compared to the CMS Quality Measures that report a percent of residents with pressure ulcers.

2015

House-Acquired Pressure Ulcer Rates 4 3 2 1 0

1 1

1 1 0 1st Quarter

1 1

1

0

2nd Quarter House

LTC

3rd Quarter

1 1

1 1 0

4th Quarter

0

Annual

Short-Term Rehab

CJE SeniorLife is a partner with the Jewish United fund in serving our community.

02.2016

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