A Perfect Partnership: Ensuring a
Safe Patient Transition with a Post
Discharge Firefighter Visit
Linda Bauermeister BSN RN MAL, Director- Nursing and Population Health
PNHS
Patti Betlach BSN RN PHN, Director- Palliative Medicine and Community
Care PNHS
Steve Koering, Fire Chief - St. Louis Park
May 20, 2014
Participants:1-866-639-0744, no code needed
A Perfect
Partnership: Ensuring a Safe
Patient Transition with a Post
Discharge Firefighter Visit
Linda Bauermeister BSN RN MAL
Director- Nursing and Population Health PNHS
Patti Betlach BSN RN PHN
Director- Palliative Medicine and Community Care PNHS
Steve Koering
Fire Chief - St. Louis Park
May 20, 2014
Objectives
At the conclusion of this webinar, participants will be
able to:
1. Learn how Park Nicollet Health Services
partnered with the St. Louis Park Fire
Department to address care transitions
2. List the components of the firefighter visit
3. Describe how the firefighter visit addresses the
triple aim of
a. Improving Population Health
b. Improving the Experience of Care
c. Improving the Affordability of Care
How our story began
• Park Nicollet has worked on patient
transitions/readmissions since 2011
– RARE participant
– Pioneer ACO
• Many changes have been made to the way
we deliver care including
– Risk stratification
– Standardized care coordination/transitions/
handoffs
– Post DC phone calls
– Improved After Visit Summaries
Average of 49 patients go home with no
services or with Home Care from Methodist
Hospital / day
Fire Department approached PN
• 70% of calls for SLP Fire Department are
EMS calls (about 10/day)
– Many of these calls are from our patients who
have been discharged
• Opportunity to impact the pre-911 timeframe
– Proactive intervention vs. reactive based on 911
call (resulting in fire, police, ambulance response)
– Reinforce discharge messages in the patient’s
home setting
• Park Nicollet said YES! Let’s partner!
Lean Methodology used to Create
Program
• PN has used Lean Methodology since 2003
– Structured approach and tools used
– Dedication to reserving resources over defined
period of time with a defined scope and targets
• Prep - 3 meetings
• Kaizen Event - 4 days (day 3 we tested visits)
• Large multidisciplinary team including 4
patient partners and 7 Fire Departments from
surrounding communities
Theme
To construct a process, tools, and
measurement plan to pilot post hospital
discharge visits by firefighters in April
2014 that addresses all elements of the
triple aim.
Targets
1. A Future state process flow including the new Post DC
Hospital Visit
2. Detailed process flow of the Post DC Hospital Visit.
3. Identified key components of the visit.
4. Identified new structures and plans - i.e. dispatch function at
Methodist
5. Creation of Tools needed to complete visit
6. Measurement plan including success measures and surveys
7. Training plan for pilot.
8. Completed visits on March 19 with results/suggestions for
improvement
9. Pilot specifics - length of pilot, pilot review plan, next steps
plan
Items included in prep meetings
• Sharing of information
– Background on our transitions work
– Readmission information
– ACO information
– Firefighter training
• Addressing misconceptions
• Identified who should be part of the team
• Finalized scope and targets
What we did over the 4 day event
• We created what we needed to test 3 Post
DC patient visits
– Overall process and 4 sub processes
– Visit components
– Tools
• We tested 3 visits and documented our
learning/issues
• We planned for the pilot including
– Measures
– Training
Processes
• Future state Patient Discharge flow process
that includes the firefighter visit
• Four sub processes- two owned by Methodist
Hospital and two owned by Fire Department
–
–
–
–
Patient ID and consent process
Dispatch process
Fire Department receipt of information process
Fire Department scheduling/pre-visit/visit process
Main components of the firefighter
visit
• Review of the following:
– Meds - does the patient know what medications
he/she should be taking?
– Red flags - does the patient know the signs and
symptoms to be aware of?
• Does the patients know who to call and when?
– Is there a follow up appointment scheduled?
• PEAT - Physical environment assessment
• Connect patient with any necessary resources
Created the tools necessary to
support the process
•
•
•
•
•
Flyer
Opt in consent form
Firefighter visit documentation tool
Patient Survey
Many other supporting items including
– Fax sheets
– Scripting
– Resource sheets
Flyer
Opt in consent form
Firefighter visit documentation tool
Patient satisfaction tool
We tested three visits
Rodger reviewing
the patient’s
information in
preparation for his
call to the patient to
schedule the visit
Visit learning's
• Each visit was different
– One focused less on the discharge content and more
on home safety
– One involved medication clarification
– One was directed around marketing the program and
addressing a condition question (bruise on ankle)
• Average cycle time of visit - 17 minutes
• Patient feedback was positive - patient quote:
“all of the info upon hospital discharge can be very
overwhelming and it helps to clarify things in the
comfort of your own home.”
We identified issues- PN side
• We have issues with the AVS-
– it’s hard to find the primary provider
– The medication section is confusing
• Meds listed multiple times
– A couple of AVS’ included the copy of “My Medications”
list that would be good for the refrigerator door - we found
out this is not an accurate list
– The appointment section does not list reason for
appointment. For example, “stress test”
• We need standard work for faxing the patient info to
Fire Department along with standard fax cover letter
• We need Ziploc bags for meds not being taken
We identified issues- Fire
Department side
• We need to work with Dispatch
– Additional codes are needed for out of area
• We need additional work on faxing process
– Tag line on fax
– Need cover letter for faxes to both the fire
department and PN HIM
• Would like to try folders and binder to hold the
documents
• Need to review the record retention requirements
for SLP
• We need a new solution to cover our feet when
entering the home. Booties don’t work
We identified issues - Fire
Department side
• We need job aides for
– where to get extinguishers charged, drop down ladders
– Difference between ionizing and non-ionizing smoke
alarms
– Fire pits/recreational fires
• We need to inform of height requirement or provide 2
step ladder to check smoke detectors
• We need criteria for a same day visit and discuss at
huddles at hospital
– i.e. lives alone
– No person on arrival when patient gets home
• Need list of pamphlets/other info needed - is there
something on the PN website we could use?
We identified issues- both sides
• Can patients who need INR’s have lab
appointment so it shows up on AVS?
• We need scripting for staff/hospitalists to
market this and make sure if the patient says
“yes” that the patient will be home
• We need a process for Head’s up email
• We need a plan so that if firefighter is in
another city they can get a lock box key for
apartments
• Can we find out if there a highlighter color
that is best to use for elderly patients?
We planned for the pilot
• We will start the pilot on May 12, 2014
and include the SLP, Minneapolis, and
Minnetonka fire departments
• Until then, we will do test visits every
week to work out the bugs and complete
other tasks so that everything is done
• A project plan has been created that
includes training, communication and
other pilot specifics.
Triple Aim Impact of the Firefighter Visit
Health
•Patients have what they need to care for
themselves at home and understand what
to do if something changes
Experience
•Safe and success transition to home
•Consistent and reinforced messages from
PN team and firefighter colleagues
Affordability
•Decrease readmissions
•Appropriate use of healthcare resources
and decrease unnecessary 911 calls
Re-cap of visits from 3/17-5/1/14
n=13
Our patient demographic data
• Gender
– Male - 4
– Female - 9
• Average age- 76 (range 25-94)
• High risk- 2 documented (form updated)
Visit info - n=13
• Ave # of times called to schedule visit- 1.6
• Average cycle time of visit - 22 minutes
• Appointment times - 9:30 AM to 1:30 PM
Visit info - outcomes of visit
Patient Feedback- n=6
• I felt Methodist Hospital staff informed me
about the firefighter visit in a way that I
could understand - 100% strongly agree
• The firefighter arrived within the arranged
time frame - 100% strongly agree
• The firefighter visit gave me confidence in
managing my medications
–
–
–
–
33% strongly agree
50% agree
17% disagree
0% strongly disagree
Patient Feedback - n=6
• Please rank the following four aspects of your
firefighter visit according to what was most helpful to
you - average ranking below
–
–
–
–
Understanding medications - 3.2
Who to call with questions - 1.8
Understanding your follow-up appointments - 2
Home Safety Survey - 3
–
–
–
–
71% strongly agree
29% agree
0% disagree
0% strongly disagree
• I would recommend a firefighter visit to my family and
friends
Patient Feedback - n=6
• Comments
– The firefighters could have been a little “warmer”
in their communication. They seemed more
“businessy.”
– Great Program!
– Especially for those patients not receiving a home
care visit/follow-up, I feel this program could be
very beneficial. All the info upon hospital
discharge can be very overwhelming and it helps
to clarify things in the comfort of your own home.
– I think they did a good job!
– Fantastic job - well worth it
Areas still requiring work
Getting patients to consent
Future State- Patient Discharge Flow
ID patients and
Opt in process?
What to document and
how to transfer info to PN
Pre-visit planning
Patient
hospitalized at
Methodist
Hospital
Discharge
planning
completed and
reviewed with
patient including
Firefighter visit
Patient discharged
to home.
Firefighter visit
scheduled.
Information
handoff to home
care or clinic.
Scheduling process with
SLP FD
Other items:
1. Plan Pilot
2. Billing and Accounting
3. Fire Department- redistribution of workload during
peak periods. Scheduling considerations if major event
4. Testing the visits during KE
5. Communication
6. Education/Training
7. Data/Reporting
8. Address political issues
9. Visit standards for statewide use
10. Credentialing
11. What vehicle to show up in.
12. Marketing needs
Firefighter visits
with patient and
documentation
completed
Patient given
survey form to
complete and send
back to PN.
Escalation process to
additional resources
Incomplete Visitspatient cancellations
DC phone call to
patient 24-72
hours post DC
Home Care visit
done or Patient
goes to clinic for
Hospital DC Visit
Questions?
Upcoming RARE Events….
RARE Action Learning Day and Reception
June 17, 2014 (8:30 a.m. – 3:30 p.m.)
Crown Plaza Hotel - Plymouth, MN
Registration now open!
Thank You…
This is the final webinar for the RARE
Campaign!
To view past webinars visit,
www.rarereadmissions.org