The Haag Pavilion Sub-Acute Unit
Lieberman Center for Health & Rehabilitation
2015 Outcomes Report through Third Quarter
Contents
Introduction ............................................................................................................................................................3 Haag Pavilion (Sub-Acute Unit) ..............................................................................................................................3 Physician Specialists at the Haag Pavilion ..............................................................................................................3 Transitional Care Nursing Program ........................................................................................................................4 Rehabilitation Outcomes ........................................................................................................................................5 Rehospitalization Rates ..........................................................................................................................................6 Satisfaction Survey Results .....................................................................................................................................6 Infection..................................................................................................................................................................7 House-Acquired/Nosocomial Infections ................................................................................................................7 House-acquired/Nosocomial Urinary Tract Infections ...........................................................................................7 Multi-Drug Resistant Organisms ............................................................................................................................8 House-Acquired Pressure Ulcers ............................................................................................................................8
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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 is current through the third quarter of 2015 and 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, respiratory therapy (i.e. tracheotomies and ventilators). She has various managerial and teaching experience.
Physician Specialists at the Haag Pavilion 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 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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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 may become involved in patient care, depending upon the origin, location and extent of the wound. Plastic surgery may be another involved discipline. Doctors also attain certification through the American Academy of Wound Management to become a Certified Wound Specialist Physician (CWSP).
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 wellbeing. This, in turn, should have an impact on reducing rehospitalizations. The following are the statistics that reflect the program’s activities.
Transitional Care Nursing 2015 100% 95% 90% 85% 80% 75%
100% 95%
100%
85%
85%
1st 1/4
98%
94%
2nd 1/4
3rd 1/4
88%
YTD
2015 % For Whom Discharge Med Reconciliation Completed % With f/u 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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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.
Haag Pavilion Overall Outcomes for Rehab 6 5 4
4 3
3 2
2
3
3
3 2
2
1 1st Quarter 2015
2nd Quarter 2015
Avg. Overall at Admit
3rd Quarter 2015
YTD
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 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
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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. The rates for a comorbidity of 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.
30 Day Rehospitalization Rates Through 3rd Quarter 2015 100%
90% 91%
80%
**Primary Admitting Diagnosis
60% 40% 20%
20% 23% 18%
10% 0% 8%
0% All Patients
Pneumonia**
15%
23% 23% 25%
21% 17% 0% 0% 0%
All Total Joint Orthopedic** Replacement** 1st Quarter
2nd Quarter
33% 33%
43%
13% Cardiac**
CHF**
3rd Quarter
All with comorbidity of ESRD requiring dialysis
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.
Satisfaction Survey for The Haag Pavilion 2015 100.0% 80.0% 60.0% 40.0% 20.0% 0.0% 1st 1/4
2nd 1/4
3rd 1/4
4th 1/4
YTD
Overall Satisfaction with Care & Services Likeliness to Recommend to Friends or Family
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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 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 the Haag Pavilion. 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 the Haag Pavilion. 2015 Nosocomial Incidence Rate 8
6.3
6.7
6
6.3 5
5
5
4.7 3.7
4
3.7
2 0 1st Quarter
2nd Quarter House
LTC
3rd Quarter
The Haag Pavilion
House-acquired/Nosocomial Urinary Tract Infections The second chart shows the rates for house acquired urinary tract infections (UTIs). This rate is monitored since this infection is the most common. Of greatest importance to note is that none of the UTIs were associated with urinary catheter usage. 2015 UTI Incidence Rate 3.7
4 3
2.7
3
2.7 2
2
2.3
2
2
1.7
1 0 1st Quarter
2nd Quarter House
LTC
3rd Quarter
The Haag Pavilion
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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 after being acutely ill. During this time many are quite compromised and susceptible to infection which frequently necessitates being treated with a number of antibiotics. The very low rates on the long term care floors are reflective of the effective management of these infections. Multi-Drug Resistant Organisms (VRE. MRSA, ESBL, C-Diff, CRE) 2015 Prevalence Rates Period used = 1 month 3.7
4 2
0.3
0.1
0
1.3
0.5
1st Quarter
0
0
2nd Quarter House
LTC
1.3
0 3rd Quarter
The Haag Pavilion
House-Acquired Pressure Ulcers 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. 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.
Lieberman Center for Health & Rehabilitation House Aquired Pressure Ulcers 2015 4 3 2 1 0
1
1
1 0
1st Quarter 2015
1
1
2nd Quarter 2015 House
LTC
1
1
1
1
0 3rd Quarter 2015
0 YTD 2015
Haag Pavilion
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Lieberman Center for Health and Rehabilitation 9700 Gross Point Road, Skokie, IL 60076 847.929.3320 www.cje.net CJE SeniorLife is a partner with the Jewish United fund in serving our community. 12.2015
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