Leader Rounding.
Does It Impact Outcomes?
Sherry Sweek, RHIA, CPHQ, CPMSM,
Director, Quality Improvement
Southeast Georgia Health System
ssweek@sghs.org, 912.466.3265
September 26, 2012
Southeast Georgia Health System
• Two hospitals: Brunswick-316 beds, Camden40 beds
• Two Nursing Homes: Brunswick-232 beds, St.
Marys-78 beds
• Physician Practices: over 79 physicians in
primary care and specialty care
• 2,200 team members
• Focus today is experience at Camden facility
Session Learning Objectives
1. Discuss how to incorporate Leader Rounding
into practice.
2. Outline the steps to implement a successful
Leader Rounding program.
3. Identify the outcomes impacted by Leader
Rounding.
P D C A (Plan, Do, Check, Act)
Quality Improvement Model
Act
Plan
Check
Do
• PLAN-How should the
problem be tackled?
Address issues
surrounding problem.
• DO-Implementation of
the plan.
• CHECK-How will the
team know the plan is
working? What data
must be collected? Test.
• ACT-How to best go
forward? Redesign?
Evaluation Step.
Plan the Improvement
•
HCAHPS scores unfavorably decreased in
August 2011 and based on drop negatively
impacted 2011 YTD scores
– Maternity HCAHPS-90th percentile
– Med/Surg HCAHPS drive overall Camden HCAHPS
•
•
Approached VP and Assistant Administration at
Camden to gain support for addressing solution
in September 2011
Situation discussed at October 2011 Camden
Patient Care & Safety Committee (oversight for
quality at operations level) with managers from
clinical and non-clinical areas
Do the Improvement
•
•
•
•
Developed standardized process (who, what,
where, when) for rounding on Med/Surg floor
Presented at next Leadership meeting with
forms
Folder on shared drive (access by all leaders)
with forms and calendar for leaders to selfschedule
Leaders agreed to pilot for three months and
measure improvement
Leader Rounding Pilot
Who:
Patients admitted within last day and
those scheduled for discharge next day
What: Rounding using standard Rounding Form and
follow-up on issues identified & turn in form to
Admin Sec
When: Leader to pick two days in Month (Mon-Fri)
Where: Med/Surg
When: You may round anytime but morning may be
better so if there are concerns you still have
an opportunity to address same day
Leader Rounding Early Wins
•
•
•
•
Supplement to bedside nurse hourly rounding
and nurse manager rounding
Admin Rounding (VP, Assistant Administrator,
Quality Director) discussed Leader Rounding
with team members and the early outcomes
Pulled HCAHPS based on discharge date to
see if scores improved
Camden Leaders seen as early adopters and
setting the standard for System rounding
Check Leader Rounding Pilot Results
Med/Surg Unit
Rate the hospital 9-10
Recommend this hospital
Communication with Nurses
Response of hospital staff
Communication with Doctors
Room and bathroom kept clean
Area around room quiet at night
Pain management
Communication on medications
Discharge information
Jan-Sep
11
Nov 11Jan 12
63%
69%
67%
54%
81%
70%
55%
64%
55%
81%
69%
74%
77%
61%
82%
85%
62%
65%
62%
89%
Check Other Results
•
Feedback:
– Leaders enjoyed rounding and felt they were
making a different
– Patients appreciated someone coming to visit
•
•
The interventions prevented problems from
becoming larger issues
Leaders could re-enforce patient safety topics
(fall prevention, calling for assistance, isolation
precautions)
Act on Results
•
•
•
•
•
Leaders agreed to continue Leader Rounding
Determined measures to track outcomes
Set 2012 HCAHPS goals to improve into next
quartile rankings
HCAHPS indicators (Communication with
Nurses, Response of Hospital Staff) shared at
Nursing leadership meetings comparing all units
throughout System
Participate in GHA Hospital Engagement
Network to impact patient outcomes
2012 Leader Rounding
• Service Excellence Coordinator rounds every
Wednesday and meets with managers to
resolve issues and address concerns
• Safety huddles to address core measure
compliance, patient concerns, infections,
issues identified)
• Leader Rounding expanded to Brunswick
Campus in April 2012 based on positive
experience at Camden
YTD 2012: No injury falls
Inpt. Injury Falls Per 1000 Inpt. Days
Camden Campus
Inpt. Injury Falls Per 1000 Inpt. Days
6 Month Rolling Average
Benchmark
12 Month Rolling Average
5.0
3.0
2.0
0.00
0.00
0.00
0.00
0.00
0.00
A
ug
12
12
lJu
12
nJu
12
2
-1
ay
pr
2
2
-1
-1
ar
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A
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b
Fe
1
-1
11
2
-1
ec
ov
1
-1
ct
n
Ja
D
N
O
11
1
-1
ug
p
Se
A
11
lJu
11
nJu
11
1
1
-1
ay
pr
-1
ar
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A
M
1
-1
1
-1
b
Fe
n
Ja
Month-Year
0.00
0.00
3.01
2.71
0.00
0.00
1.39
1.68
0.00
0.00
1.61
0.00
0.0
1.40
1.0
0.00
# of Inpt Injury Falls/1000 Inpt Falls
4.0
Med/Surg: Formal Compliances &
Grievances
Number of Complaints
20
15
12
10
8
5
0
2011
Annualized
2012
Core Measures 2012 results
Composite Score
2011
JanJun
2012
US Top
Quartile
Heart Attack
100.0%
No pts
99.7%
Heart Failure
85.9%
84.0%
98.4%
Pneumonia
92.0%
88.7%
97.6%
Surgical Care
98.2%
98.0%
98.4%
(# of interventions
completed/# of interventions
applicable to patient)
Red
0-25th percentile
Yellow
26th-50th percentile
Green
51st-75th percentile
Blue
76th-100th percentile
US top quartile based on hospital compare data for time
frame Q4/10-Q3/11 on whynotthebest.org
Pneumococcal Vaccination
Jan-12:Pneumo Immunizations expanded to high risk
patients
100.00%
90.90%
91.30%
94.70%
Jan-12
Feb
Mar
100.00% 100.00%
93.30%
80.00%
60.00%
40.00%
20.00%
0.00%
Apr
May
Jun
2012 Core Measures Misses
• Physician
Impact:
83%
• Nurse
Impact:
17%
100.0%
20.0%
28.6%
40.0%
28.6%
60.0%
42.9%
% of variances
80.0%
NA
0.0%
PN
HF
SCIP AMI
Other 2012 Outcomes
• Zero hospital acquired conditions
–
–
–
–
–
–
–
–
Foreign object retained after surgery*
Air embolism*
Blood incompatibility*
Pressure Ulcer stage III or IV*
Falls & trauma
Vascular catheter-associated infection*
Catheter-associated Urinary Tract Infection*
Manifestations of poor glycemic control
• Zero patient safety indicators
–
–
–
–
–
Death among surgical inpatients with serious treatable complications
Latrogenic pneumothorax
Post-Op PE or Deep Vein Thrombosis
Postop wound dehiscence
Accidental puncture or laceration
Questions?
Questions: Sherry Sweek, 466-3265 or ssweek@sghs.org