MEDICAL CONNEC TION
AUGUST
17 2012
Georgia Health Sciences Physicians and Clinical Staff
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2. Welcome 4. New Faces of GHS 5. Case Managers
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Contact information: Medical Connection is published monthly except for July and December for GHS physicians and clinical staff. •
Dr. William Kanto—Senior Vice President
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Carole Poe—Medical Connection Liaison
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Publications Director—Christine
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Editor/Designer—Patricia Johnson
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Photographers—Patricia Johnson, Phil
for Medical Affairs and Chief Medical Officer, Georgia Health Sciences Health System (kanto@ georgiahealth.edu) (cpoe@georgiahealth.edu)
6. Social Workers 7. Hospital Epidemiology 9. Utilization Review 11. Patient Well-Being
Hurley Deriso (cderiso@georgiahealth.edu)
(pjohnson1@georgiahealth.edu) Jones, and Stock X-Chng
Links: www.georgiahealth.org
Welcome to Medical Connection Dr. William Kanto Senior Vice President for Medical Affairs and Chief Medical Officer
Communication is one of a successful enterprise’s most important functions. Confusion and frustration reign when a message misfires or lacks clarity. Political consultants say a message must be repeated seven to 11 times before a target audience recognizes it—a clear indicator of why it is often difficult to communicate effectively. To further complicate matters, health care in general and our enterprise in particular is undergoing significant changes, making it difficult to keep everyone up to date.
“Our faculty members understandably prefer to focus on their top priorities—education, patient care and research—but the plethora of changes, the complexity of our patients and the need for a team approach to health care require effective communication.”
We must keep the lines of communication open even if the message is not to our liking or foremost in our interest at that particular time. With that in mind, we welcome you to the inaugural edition of Medical Connection, a way for the medical staff office to communicate with the medical and house staff. We plan to publish this digital newsletter 10 times per year, using it to introduce new colleagues, communicate changes in our functions and structure, and familiarize you with areas
critical to our mission. We hope this helps fill in the communication gap. We welcome your feedback about how to make Medical Connection more interesting and useful. I would like to use the inaugural issue to make everyone aware of a significant impediment to patient satisfaction and efficient care. I am referring to the almost daily problem of long waits in admitting our patients to the hospital. The delays usually stem from inefficient discharges. Approximately 85 percent of our discharges occur after noon. Lowering this figure to 50 percent—the benchmark of efficient organizations—would greatly minimize admission time for incoming patients. We need everyone on board to solve this problem. Discharge can be expedited by completing as many steps as possible in advance, including patient education and arranging home health services, follow-up appointments, placement and transportation. Contemplated discharge orders should be entered into CPOE for patients likely to be discharged within 24 hours, alerting staff and allowing ample preparation time. No penalty applies if the patient stays beyond the date noted on a contemplated discharge order; the patient’s care continues uninterrupted.
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Welcome to Medical Connection Continued...
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“The medical and house staffs’ first order of business should be to see patients who might be ready for discharge, then writing their discharge orders if appropriate.” Many members of our team are already taking a leading role in this initiative. For instance, Department of Medicine Chair Mike Madaio has improved his work flow process to optimize discharge efficiency, and the Department of Surgery is following suit. Everyone’s cooperation on this initiative will increase patient satisfaction and improve our efficiency as an enterprise. Please feel free to contact me with questions and/or suggestions.
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Writing contemplated discharge orders (including special instructions) for patients who might be discharged with 24 hours.
Seeing patients slated for discharge as early in the day as possible. Writing discharge orders by 10 a.m., if possible, to ensure discharge by noon.
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Adam Becker, M.D., Otolaryngology Andrea Prosser, M.D., Ophthalmology
Bunja Rungruang, M.D., Obstetrics/Gynecology, Gynecologic Oncology Christa Pepitone, M.D., Family Medicine Clark A. McDonough, D.O., Medicine/Pulmonary Medicine Clyde J. Smith, M.D., General Pediatrics Daniel Heine, M.D., General Pediatrics David Jang, M.D., Otolaryngology David Kriegel, M.D., Family Medicine Debra T. Moore-Hill, M.D., Neurology Eran Rotem, M.D., Interventional Radiology George Harris, M.D., Pediatric Otolaryngology Hal G. Bowers, M.D., Vascular/Interventional Radiology Jaswinder S. Rattan, M.B.B.S., Medicine/Nephrology Jeremy R. Anthony, M.D., Medicine/Internal Medicine Lance Evans, Ph.D., Psychiatry and Health Behavior Lu Huber, M.D., Medicine/Nephrology Marcie B. Alisangco, D.O., Medicine/Rheumatology Matthew D. Steimle, D.O., Emergency Medicine Michael Ferguson, M.D., Emergency Medicine Michelle Cintron, D.O., Orthopaedics/Physical Medical and Rehabilitation Mona Hanna, M.B.B.S., Psychiatry and Health Behavior Nancy Solowski, M.D., Otolaryngology Nathasha M. Savage, M.D., Pathology/Hematopathology Olivier Rixe, M.D., Medicine, Hematology/Oncology Pascha E. Schafer, M.D., Medicine/Cardiology Ravindra Kolhe, M.B.B.S., Pathology Rebecca S. Napier, M.D., Medicine/Internal Medicine Sanjay Dwarakanath, M.B.B.S., Pediatric Anesthesiology Shvetank Agarwal, M.B.B.S., Anesthesiology and Perioperative Medicine Stephanie Lareau, M.D., Emergency Medicine Stephen H. Bush, M.D., Obstetrics/Gynecology Subhashini Ramesh, M.B.B.S., Neurology/Neuro-Critical Care Thomas W. Kiernan, M.D., Medicine/Gastroenterology William Duke, M.D., Otolaryngology William R. Maddox, M.D., Medicine/Cardiology William Vaughn McCall, M.D., Psychiatry and Health Behavior (Chair)
W E LC O M E
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Case Managers Ensure Smooth Discharge Plans Patricia Johnson
from inpatient care to the next step, requires a level of mental gymnastics generally not covered in medical school (or any other school, for that matter). Case managers work with all inpatient services in both Georgia Health Sciences Medical Center and the GHS Children’s Medical Center to ease this process for all concerned.“Their primary function
is to facilitate the discharge or transfer of patients, making the process as smooth, timely and well-coordinated as possible.” This
Paula Price MSN, APRN-BC
Critical care and self-care are extremes
on a continuum, with the distance between a vast expanse—particularly considering that no one is discharged from the hospital totally well. That distance seems to broaden as the time for discharge moves closer. Family members’ anxiety increases when they realize that the responsibility of caring for their loved ones will soon shift back to them. Health care team members feel anxious, too, knowing they soon will be directing patient care from a distance.
“How can we minimize stress during the transition from hospital to home?” Understanding
how patients move between the extremes, especially as they transition
benefits both families, who are relieved about the support they will receive after discharge, and our institution, which is assessed on benchmarking factors including length of stay. Of course, financial outcomes also improve with shorter lengths of stay. Case management is a win-win situation. Case managers rely on good communication with families and the health care team to ensure that patients are well-prepared for the transition to outpatient care or care
“Progress notes, multidisciplinary meetings and direct communication with attending physicians are helpful in sharing information about prognosis, family dynamics, timing of future procedures and anticipated date of discharge.” in another facility.
Information like this helps case managers reinforce patient expectations and determine the need for additional education or resources. Early communication also enables case managers to help place patients needing long-
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Ensure Smooth Discharge Plans Continued... term or rehabilitative care.“Not all insurance plans are alike, so benefits for outpatient and rehabilitation services vary widely. When preparing patients for discharge, early consultation with a case manager can help
identify what resources are covered.” This prevents awkward moments by ensuring that care or services discussed are actually available (i.e., reimbursed). We, as an institution, benefit when all team members providing a consistent message.
Remember: Contact your patients’
case managers early and update them often. Please work together to ensure safe and timely discharge plans. Involve patients and families in discharge planning. The smoother the process, the more everyone benefits.
Social Worker ’s Days Patricia Johnson
Takiyah Milton M.Ed. Social Worker
Defined by Beep, Beep, Beeps
Social Workers are often the overlooked, unsung heroes that turn desperate situations into positive outcomes for patients and their families.
“Beep, beep, beep.
And the pages just keep coming: a patient in a rehabilitation center suddenly requires rehospitalization . . . or a widower physically unable to return to an empty house needs to find a personal care home . . . or medical equipment must be set up in a home . . . or a patient’s transportation must be arranged.”
“These vital members of the health care team often begin their day with a beep, beep, beep of a pager before stepping foot in the hospital.” The
first call could be about a 94-year-old dementia patient who needs help transitions from home to a skilled nursing facility. Another page might involve a terminally ill 52-year-old who needs family care at home but whose only viable caregiver in on active duty in Iraq. Next might be a call from the Emergency Department about a young child with non-accidental trauma, necessitating an incident and family-dynamics assessment, followed by a safe discharge plan. Don’t forget the air flight that must be arranged for an intensive-care patient, or the community resources that must be identified for a father of four diagnosed with late-stage cancer. His stay-at-home wife is weeping at his bedside wondering how the bills will get paid. “The
social workers maintain a daily patient log documenting an endless series of beep, beep, beeps. Then the next day starts.”
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Hospital Epidemiology Slams Door on Infections
Stopping infections in their tracks—or
better yet, barring their entry to GHS clinical facilities in the first place—is job one of the Department of Hospital Epidemiology and Infection Control.
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Preventing/controlling infections and epidemiologically significant organisms
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Analyzing procedure- and device-associated infections
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Identifying and investigating infection clusters or outbreaks
Implementing evidence-based interventions to prevent infections
Evaluating methods and technologies to reduce transmission of pathogens Implementing infection prevention and control policies
Teaching employees/trainees about infection prevention
Working with health care providers to manage patients and employees with communicable diseases
Communicating with public health departments about communicable diseases
10. Collaborating on infection-related occupational health and safety programs 11. Advising senior leaders about infection risk reduction and regulatory requirements
12. Overseeing ongoing quality assessment, quality improvement and infection risk reduction
F U N C T I O N S E P I D E M I O L O G Y
“The department promotes patient and staff safety by reducing the risk of acquiring and transmitting infections; overseeing health care epidemiology, infection prevention and control; and supporting GHSU’s tripartite mission of patient care, research and teaching.”
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Slams Door on Infections Continued...
Infections Committee Chair Peter
Rissing oversees the program. The committee meets quarterly, presenting and discussing hospital-acquired infections (central lineassociated bloodstream infections, catheterassociated urinary tract infections, ventilatorassociated pneumonias, surgical site infections, etc.) and device utilization rates, among other related topics.
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Dr. Peter Rissing
• – Adult Medical Center Epidemiologist, Infections Committee Chair, Infectious Disease Faculty
Dr. Chitra Mani
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The Infection Control Manual
http://hi.georgiahealth.edu/hep/PoliciesandProcedures_3.htm,
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Wanda Gillespie—
First line of reference for employees and trainees.
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• Nurse Epidemiologist
Alicia Grant
• — Nurse Epidemiologist
• — Children’s Medical Center Epidemiologist, • Pediatric Infectious Disease Faculty Nurse Epidemiologist
Rebecca Walker
Amanda Green—
• — — Hospital Epidemiology Program Director • Hospital Epidemiology Program Administrative Specialist • — Hospital Epidemiology Program Educator
Donna Goins
Michael Lobaugh
Phil Jones Peter Rissing, M.D. Infections Committie Chair
“A Hospital Epidemiology staff member is available weekdays from 8 a.m. to 4:30 p.m., and health care team members take call after hours. Call ext. 1-2224 to contact the department. Nurse and physician epidemiologists may be paged or contacted through email.”
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Utilization Review Dr. Johnathan R. Gore Chief Hospitalist, Utilization Management Medical Director
Serves Everyone’s Best Interests
Phil Jones
For the first year as Medical Director of Utilization Management, the term “UR” prompted memories of my mother saying, “UR in trouble.” But I’ve since grown fond of the term (Utilization Review) because it is helping GHSU succeed and become the quaternary-care institution we hope to be. “In an environment of shrinking
reimbursement, physicians should not only accept, but embrace, UR. Simply put, if UR doesn’t work, physicians don’t get paid.”
UR is simply placing the appropriate patient in the appropriate hospital bed. “The appropriate patient” means determining whether a patient meets inpatient criteria, needs a short-stay observation or doesn’t need to be in the hospital at all. “The appropriate bed” means determining whether the patient needs minimal care and will likely be out of the hospital within 48 hours, requires longer-term and more intense care or can be treated as an outpatient.
These determinations result from evidence based criteria called InterQual Criteria, which is based on severity of illness and intensity of service. Severity of illness determines whether the patient’s condition is serious and complex enough to warrant hospital admission, whether as an observation patient or inpatient. Intensity of service refers to whether the level of care requires hospitalization. “Sounds simple. But if we don’t
get it right, we don’t get paid.”
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Serves Everyone’s Best Interests Continued...
Dr. Johnathan R. Gore Chief Hospitalist, Utilization Management Medical Director
Phil Jones
Not understanding the game, or not wanting to play, is no longer an option. We as an enterprise are losing hundreds of thousands (if not millions) of dollars because we do not understand the value and importance of UR. Don’t hesitate to contact me for more information at ext. 1-3159 or jgore@ georgiahealth.edu.
“Please believe and trust that our physician-led UR team is about protecting you and the broader enterprise at large. If you are paged by one of our nurses, please respond and cooperate.”
E X A M P L E S • A physician who admitted a patient not meeting inpatient criteria was called several times to change the admit type or provide further documentation to justify inpatient care. His failure to respond resulted in a $28,000 loss in reimbursement. • A surgeon’s mislabeling of an inpatient as an outpatient resulted in a $10,000 loss in Medicare funding.
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Patient Well-Being Top Priority for Quality Management
shooting issues related to systems or processes.” They
Phil Jones Quality
Management is a vital component of any successful enterprise. But nowhere is that more true than in a patient care setting. The Georgia Health Sciences Quality Management Department ensures quality control in a wide variety of ways, including monitoring outcome measures. For instance, there are multiple work groups that have been working to improve our compliance with core measures (acute myocardial infarction, heart failure, pneumonia, surgical care, and asthma care) and report their findings to the Centers for Medicare and Medicaid Services. Quality Management also is involved in any event involving “critical incident” or “sentinel event” patients. “The staff teams with
Risk Management and the clinical staff to evaluate the event, establish a timeline leading up to the event and help the Chief Medical Officer conduct a root-cause analysis to prevent recurrences by trouble-
also coordinate the follow-up on any identified risk-reduction strategies. Physician members of the Performance Improvement and Peer Review Committees work with Quality Management to help evaluate patient care. The major services are represented on both committees, helping to evaluate care, services and outcomes. Reviews or information are occasionally requested from services not represented on the committees, and their committee representation is invited if the requests become routine. Quality Management also ensures compliance with the standards and guidelines of accrediting agencies, including the Joint Commission, CMS and Department of Community Health.
“Ongoing readiness initiatives include communicating changes in standards, helping revise policies and procedures and performing internal audits to educate and prepare staff for unannounced visits from these agencies.” The department handles patient/family grievances and concerns, manning approximately 175 calls a month. Quality Service Coordinators contact the medical staff when indicated to help resolve concerns, including scheduling a patient conference if needed. Coming editions of Medical Connection will highlight different areas of Quality Management so everyone involved can improve the safety and quality of patient care.