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Pursuing
High Value
Healthcare
Optimizing Laboratory Testing
Webinar #6
July 16, 2015
Agenda
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 Welcome
 Data Team Updates


Current data and reports
Discussion
 Team Status Reports
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Progress/Activities Since Learning Session
 Phase 2 of Collaborative Meeting Time Reminders
● Next Steps
 Action Period
Our First Collaborative: Global Aim
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We aim to reduce harm to patients and conserve system resources by optimizing the use of
laboratory tests for patients cared for in our region’s hospitals.
We will use a collaborative approach considering the best medical evidence and quality
improvement science.
It begins with an evaluation of current test ordering profiles and patterns followed by an
organized plan to optimize testing and ends with a plan to sustain these practices.
By doing this we expect to reduce cost and improve satisfaction and quality of care for patients
and the health system.
It is important to work on this now because as health care professionals we can play an
important role in health care reform by designing more patient-centered, efficient and high
value inpatient care.
Data Update
 Site visit findings
 Institution specific data reports
 Consolidated database reports
 Next steps
Project Target Population
 All adults with an inpatient hospital stay > 24 hours in length, excluding
maternity, inpatient psych and swing bed patients
What does “inpatient” mean? When does admission time start?
 Inpatient > 24 hours
 ER visit > 24 hours?
 Observation bed > 24 hours?
 Same Day Surgical care > 24 hours?
 ER
Observation
Inpatient?
Project Target Population
 All adults with an inpatient hospital stay > 24 hours in length, excluding
maternity, inpatient psych and swing bed patients
Excluding Patients
 Maternity & childbirth related, excluded using MDC codes 14 & 15 or DRG codes
765-795
 Inpatient psych, excluded prior to data submission when possible. Additionally,
excluded using DRG code 885
 Swing bed, excluded using discharges with no DRG code assigned
Dropping Missing DRG codes
 Swing bed patients are typically not assigned a DRG code
 What other patients are typically not assigned a DRG code?
 Observation
only patients?
 Other?
 What patients might we inadvertently drop if we exclude all discharges with a
missing DRG code?
 DISCUSSION
Defining Length of Stay
 Length of Stay in hours = (discharge timestamp – admit timestamp)
 Length of Stay in CDC days = (discharge date – admit date)
 Length of Stay in calendar days = ((discharge date – admit date) + 1)
Defining Length of Stay
For example, suppose a person gets admitted at 10:02am on June 2nd and
discharged at 4:10pm on June 3rd
 Length of Stay in hours = (6/3/2014 16:10 – 6/2/2014 10:02) = 29.13 hours
 Length of Stay in CDC days = (6/3/2014 – 6/2/2014) = 1 day
 Length of Stay in CDC days = ((6/3/2014 – 6/2/2014) + 1) = 2 days
Defining Length of Stay
For example, suppose a person gets admitted at 10:02am on June 2nd and
discharged at 4:10pm on June 3rd
But what does “admitted” mean?
 Was the patient admitted to the ER at 10:02am?
 Was the patient assigned a bed as on “observation” patient at 10:02am?
 Was the patient admitted as an inpatient at 10:02am?
Defining Admit Time
1. Identify individual discharges
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using a unique visit number in the admission data file, unique visit number
2. Link all labs associated with an individual discharge unique visit
numbers
Sometimes the unique visit number is in the Lab data file
 Sometimes we link on MRN and dates of service
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3. Labs are associated with a visit if they are within 24 hours of the
available admit timestamp
Labs Within 24 hours of Admit Timestamp
Goal: to ensure we obtain labs that were collected when a patient
was in the ER or an observation bed prior to being admitted as an
inpatient
 If labs were collected within 24 hours prior to the available admit
timestamp, the earliest collection time is used as the “admit time”
when calculating length of stay
For example, suppose a person goes to the ER on June 2nd at 6:11am and has a
CBC drawn at 8:01am. The patient then gets admitted as an inpatient at 10:02am
on June 2nd and discharged at 4:10pm on June 3rd. The “admit time” used to
calculate length of stay will be 6/2/2014 08:01.
Labs Within 24 hours of Admit Timestamp
By only including labs that were collected within 24 hours prior to
the available admit timestamp, what issues might come up?
 If a patient has labs for an elective surgery done 7 days prior to the
admission they will not be included. BUT if the are done the day
before surgery they might be…..
 Other concerns? DISCUSSION
CBC rates per patient day (HGB)
CHEM rates per pt day (CREAT)
CHEM rates per pt day (K)
CBC rates per first 24 hours of visit (HGB)
CHEM rates per first 24 hours of visit (CREAT)
CHEM rates per first 24 hours of visit (K)
Next Steps
1. Finalize length of stay definitions
2. Finalize inclusion/exclusion criteria
3. Support sites to continue monthly data uploads
4. Define monthly DRG severity values
5. Include LFT and Cardiac Biomarker lab tests
6. Support Year 2 of the Collaborative (explore lab values? Explore
DRG specific ordering patterns?)
Team Progress Reports
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 RRMC
 Brattleboro
 NVRH
 Bennington
 Porter
 DHMC
 CVMC
 UVMMC
Any updates from the teams
to share on advances since
our Learning Session at
Dartmouth?
Kick-Off
Week 1
Collaborative Timeline
Sept 10, 2PM
Action Period
5-6 weeks
Learning
Session 1
Oct. 25
8:30 to 3:30
Continuous Coaching/Faculty Support
Conference
Call /
Webinar
Nov 19, 2PM
Conference
Call /
Webinar
Dec 17, 2PM
Learning
Session 2
Jan.14, TBD
8:30 to 3:30
Learning
Session 4
Jun. 9 TBD
8:30 to 3:30
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Conference
Call/
Webinar
Feb. 18, 2PM
Conference
Call /
Webinar
May 12, 2PM
Conference
Call /
Webinar
Mar 24, 2PM
Learning
Session 3
Apr. 14 TBD
8:30 to 3:30
Next Steps
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 Action Period
 Continue to review and submit data
 Test change ideas
 Measure results
 Adjust as needed
 Test again or try new change idea
 Support
 Faculty and Data Team are here to support you!
 Next Webinar- August 13th, 2PM