INNOVATION IN READMISSION REDUCTION — USING COMMUNITY VOLUNTEERS TO DECREASE CHF READMISSION Alma Villanueva, RN, Director of Case Management
LEARNING OBJECTIVES • Develop innovative ways to decrease readmission for a targeted patient population • Illustrate how engaging the community through a select volunteer program can assist patients and family members through self-advocacy • Identify community resources that can be used in collaboration with the hospital to improve overall population health
BACKGROUND/IMPLICATIONS FOR CASE MANAGEMENT • Unplanned readmissions are costly and often an important indicator of a hospital’s quality of care and effectiveness that can negatively impact a patient’s health and quality of life. • As pressure and demands increase to prevent readmissions post discharge, our hospital’s case management team has developed multiple approaches to help decrease the likelihood of a patient requiring an unintended return.
PROBLEM/ISSUE • The ability to make and keep follow-up appointments is an important determinant as to whether an individual’s healthcare needs can be managed successfully as an outpatient after being discharged from the hospital.
Number of patients appropriate for assistance
568
547
• To help address this particular risk factor for readmission, case management implemented an innovative approach to support transitions of care by engaging our hospital’s community volunteers as a resource and training them to assist CHF patients with the often frustrating task of making timely outpatient follow-up appointments.
Number of patients missed due to unexpected or weekend discharge
194
259
Number of appointments made
188
162
Number of patients who attended the appointments
118
126
Number of patients who declined assistance with appointments
186
191
IMPLEMENTATION STRATEGIES
30-day readmission rate for patients who attended appointments
2.5% (3 patients)
1% (1 patient)
Source: Hospital Data
Source: Hospital Data
Overall 30-day readmission rate for patients during study period
16.5%
13.4%
Source: Vizient
Source: Vizient
• Of 210 total volunteers at our hospital, five were picked to be assigned to the CHF program. They were trained in aspects of service quality and were given specific scripting around how to assist patients with outpatient follow-up visits. • Volunteers utilized a daily specific work list of admitted CHF patients generated through the electronic health record. • A volunteer visited each CHF patient to offer assistance with making follow-up appointments with Cardiology and/or Primary Care.
• Patients were assisted in obtaining follow-up appointments with both affiliated and nonaffiliated cardiologists and primary care physicians.
• To help address this particular risk factor for readmission, we have engaged our hospital’s community volunteers as a resource.
(Year to Date)
857
• Lack of follow-up is often preceded with the following challenges:
- Patient may be feeling too ill to make appointment calls.
Oct. 2018
867
• The volunteer made the appointment call from the patient’s room in order to include the patient in the process. The patient/caregiver was physically present to be part of the dialogue with the physician’s office. All necessary appointments were made.
- Patients and caregivers may encounter busy office staff who also lack knowledge of the timeliness necessary for follow-up of certain medical conditions such as CHF.
2017 Total number of patients screened for assistance
• In our complex teaching hospital, we have determined that an important contributor to congestive heart failure (CHF) readmissions is a lack of timely follow-up with the specialty consultant or the primary physician.
- Issues with communication, patients’ inability to advocate for themselves and a lack of understanding of the importance of the time frame required for outpatient follow-up.
DATA TO TRACK OUTCOMES
PROCESS FOR ASSISTING CHF PATIENTS WITH FOLLOW-UP APPOINTMENT
TOP REASONS FOR DECLINING VOLUNTEER ASSISTANCE • • • • •
Family member will make appointment Patient prefers to make own appointments Patient wants to speak to physician prior to making appointment Patient already had appointment Other
CONCLUSIONS • Difficulty making follow-up appointments can contribute to clinical decompensation at home, resulting in readmission. • Our volunteer appointment assistance program, while still in its early stages, has helped to avoid hospital readmissions in our CHF population. • In 2017, overall 30-day readmission during the study period was 16.3% while 30-day readmission rate for patients assisted with follow-up appointments using the volunteer initiative was 2.5%. 2018 YTD is showing an even better result. • A critical component of the initiative is the direct involvement of the patient or family member with appointment creation and the volunteers’ modeling of appropriate self-advocacy. • Early success with our volunteer discharge planning program suggests that CHF patients may benefit from directed, scripted assistance with obtaining critical outpatient follow-up appointments.
Volunteers help CHF patients make follow-up appointments using pre-programmed portable phone at bedside.
Special Acknowledgements: Tere Jackson, Manager, Volunteer Services Carla Braxton MD, Chief Quality Officer Debra Welch, RN, Case Management Department Lourdes Hernandez, Volunteer Service Secretary Our volunteers: Linley Wilkins, Fred Quell, Marcia Mills, Anne Thorpe, Lori Carrel, Susana Castillo