The Haag Pavilion Sub-Acute Unit Lieberman Center for Health & Rehabilitation 9700 Gross Point Rd. Skokie, IL 60076 847.929.3320 www.cje.net and LiebermanCenter.net 2016 3rd Quarter Outcomes Report
09.2016
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Contents
Introduction .................................................................................................. 3 Haag Pavilion (Sub-Acute Unit) ..................................................................... 3 Physician Specialists at the Haag Pavilion .................................................. 3-4 Transitional Care Nursing Program ............................................................ 4-5 Rehabilitation Outcomes ........................................................................... 5-6 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 The Haag Pavilion Sub-Acute Unit at Lieberman Center for Health and Rehabilitation (LCHR). This report for 2016 consists of outcomes directly related to patient care.
Haag Pavilion (Sub-Acute Unit) The Haag Pavilion offers these 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 full and a part time staff nurse practitioner; a full time 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: physiatry, cardiology, nephrology, infectious disease, psychiatry, neuropsychology, and wound care. 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, transplant aftercare, and respiratory therapy (i.e. tracheotomies and ventilators). She has various managerial and teaching experiences.
Physician Specialists at the Haag Pavilion Cardiology Dr. Caesar De Leo 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 supported by the NorthShore University Medical Group Department of Nephrology. His expertise and our personalized clinical services allow for optimal care and outcomes.
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 is Board Certified in Physical Medicine and Rehabilitation. His areas of interest are Geriatric Rehabilitation and Musculoskeletal Medicine.
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Podiatry Dr. Brian Aronson received his D.P.M. from the Scholl College of Podiatric Medicine. His memberships and Affiliations include: Present Member American Podiatric Medical Association-1994; Present Member Illinois Podiatric Medical Association-1999 and Present Illinois Licensed Podiatric Physician1999. He also received a Scholl Merit Scholarship from 1994-1995.
Wound Care 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 the Haag Pavilion instituted a Transitional Care Nursing Program. This program was implemented and is managed by 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. Among the actions that are taken are providing additional education regarding care, medication, and following up with the patient’s primary care physician (PCP) in the community and a follow up well-being call. She also coordinates efforts with the Primary Care Physicians’ Nurse Practitioners and Physician Assistants to enhance the quality and communication for follow up care after discharge. On average this nurse spends a minimum of eight hours with each patient during the discharge process. The augmentation of this program to the discharge process is intended to promote the goals of increased compliance by the patient/family thus improving the patient’s well-being. This, in turn, should have an impact on reducing re-hospitalizations. The following are the statistics that reflect the program’s activities.
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Transitional Care Nursing 2016 100%
100%
100%
100%
100%
79%
76%
80%
100%
100%
100%
100%
97%
99%
90%
99%
100%
100% 60% 40% 20% 0%
2015 Annual
2016 2016 1st Quarter 2nd Quarter % For Whom Discharge Med Reconciliation Completed
2016 3rd Quarter
% With f/u PCP Appointment Made Within 7 Days of Discharge % With PCP Appt. Made Who Kept Appointment % With Documented Hand Off to PCP
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
2016 Haag Pavilion Overall Outcomes for Rehab 6 5 4 3 2 1
4 3
2015 Annual
4
4
3
3
2016 1st Quarter Series1
2016 2nd Quarter
4 3
2016 3rd Quarter
Series2
5
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 the Haag Pavilion, 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
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. Note: CY16:Q3 overall readmission rate is 6%, which is well-below national average 20%.
2016 30 Day Rehospitalization Rates
100% 80% 52%
60% 40% 20%
19%15%16%
6%
0% All Patients
39% 30% 17%
17% 13% 0%
42% 34%
33% 10%
Pneumonia** All Orthopedic**
0% 0%
22%
30%
13%
0%
Total Joint Replacement**
Cardiac**
8% 10%
0%
CHF**
** Primary Admitting Diagnosis 2015 Annual
2016 1st Quarter
2016 2nd Quarter
2016 3rd Quarter
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Satisfaction Survey Results Satisfaction Surveys are conducted on a regular basis. They utilize a tool that was developed by Symbria, an independent analytics company. The surveys are sent to Symbria, who analyzes the results and submits a report to Lieberman on a regular basis. Please note that in CY16:Q3, the survey results were put on hold for two months and our numerator was well below the base line of previous quarters. However, when adjusted over a three-month period, Overall Satisfaction is 87.45% and Likely to Recommend is 83.25%, which is in alignment with previous quarters.
Satisfaction Survey for The Haag Pavilion 2016 91%
90%
100%
86%
82%
80%
53%
60%
52%
40% 20% 0% 1st Quarter
2nd Quarter
Overall Satisfaction with Care & Services
3rd Quarter
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 in order to provide quality care.
House-Acquired/Nosocomial Infections
Rate per 1000 Patient Days
The first chart contains the rates for the incidence of all house acquired infections. Note that the infection rates tend to be higher in the first quarter of the year when colds and flu are prevalent. 2016 Nosocomial Incidence Rates 10 5
4
4
5
5
4
6
5
5
5
7
6
9
0 2015 Annual
2016 1st Quarter House
LTC
2016 2nd Quarter
2016 3rd Quarter
The Haag Pavilion
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House-acquired/Nosocomial Urinary Tract Infections
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.
Rate per 1000 Patient Days
2016 UTI Incidence Rates
4
3
3
2
2
2
2
2 1
1
1
2
2
2
2
1
0
2015 Annual
2016 1st Quarter House
LTC
2016 2nd Quarter
2016 3rd Quarter
The Haag Pavilion
Multi-Drug Resistant Organisms The third chart reflects the prevalence of multidrug organisms. 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 the Haag Pavilion. 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.
Rate per 1000 Patient Days
2016 Multi-Drug Resistant Organisms (VRE. MRSA, ESBL, C-Diff, CRE) Prevalence Rates Period used = 1 month
4 3 2 1 0
2 0
0
2015 Annual
0
0
1
2016 1st Quarter House LTC
1
1
2
2016 2nd Quarter The Haag Pavilion
0
1
1
2016 3rd Quarter
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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 as compared to the CMS Quality Measures that report a percent of residents with pressure ulcers.
2016
House-Acquired Pressure Ulcer Rates 4 3 2 1 0
1
1
0
2015 Annual
1
1
0
2016 1st Quarter House
LTC
1
1
0
2016 2nd Quarter
1
1
1
2016 3rd Quarter
The Haag Pavilion
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