Family Medicine HealthNet
Inpatient Service
QUALITY REPORT AND UNIT DASHBOARD: BMC E6W
QUEST: (QUALITY, EFFICIENCY, SATISFACTION AND TOTAL REVENUE)
October 03, 2014
Leadership Team
Christopher Manasseh, MD
Assistant Professor
Vice Chair for Inpatient and Hospital Services
Aram Kaligian, MD
Assistant Professor
Assistant Inpatient Director
Jonathan Bunker, BSN, RN
Nurse Manager
Eileen Mullaney, RN
RN Care Manager
Charlotte Cuneo, MSN, RN, CCAP
Clinical Nurse Educator
_______________________________________
Toyin Ajayi, MD
Hospitalist Medical Director
Director of Transitional Medicine
Commonwealth Care Alliance
Ted Constan
Chief Administrative Officer,
Department of Family Medicine
Erica Cuevas, MPH
Administrative Coordinator
Gwyneth Jones, MBA
Administrative Manager
Brian Jack, MD
Professor
Chair, Boston University Department of Family Medicine
Chief, Boston Medical Center Department of Family Medicine
Jessica Martin, MA, MPH
Program Director
Introduction
This is a Quality Report describing the activity of the Family Medicine - Boston
Health Net (FM-HN) Inpatient Service located on 6W of BMC’s East Newton
Campus.
The purpose for this Dashboard is to document and share the quality of the service
with senior leaders and other constituents
FM-HN service accepts admissions from the family medicine practices at BMC and
the CHCs and from the Boston Community Health Group (BCMG) which cares for
high risk frail elders and disabled/homebound patients in our communities.
As we continue with rapid PDSA (Plan-Do- Study- Act) cycles of improvement, and
show improvement -- some graphic elements are dropped and are replaced by
other priorities.
Introduction
These reports show areas in which we are doing well – and not so well – but that through this process
we hope to continuously improve.
The idea for collecting these data metrics emanated from the concepts of teamwork and the desire to
provide high quality services among the partners.
To begin, we organized a weekly meeting among the stakeholders designed to define the mission and
the members of the team and to identify clear objectives that we would try to achieve.
The principles of collaboration and objectives for the inpatient team are listed on a poster that hangs
in the entry of the unit (shown on the next slide).
The metrics developed that are shown in this report are an attempt to quantify each of these
principles.
The data are organized according to the BMC QUEST pneumonic (Quality, Efficiency, Satisfaction, Total
Revenue).
Principles of Collaboration for E6W
Family Medicine, Boston HealthNet Inpatient Service
Principles of Collaboration for 6 West Inpatient Unit
Partners: Patients, Physicians, Nurses, Community Health Center Administration and Staff, Boston Community Medical Group, Physician Assistants, Consulting
Services, Students, Nursing Education, Pharmacists, Physical and Occupational Therapists Environmental Services, Nutrition and Dietary and Community-based
1
providers including rehab units and SNFs
Our Mission: To provide safe, high quality, evidence based, efficient, patient centered care at all times in an environment of
collaboration and team work.
Team Focused
• Responsibility for care rests with a team of
professionals rather than a single provider.
• Patient Care is a shared responsibility
• Team includes outpatient partners
• Implement Teams training
Clarity of Responsibility
• The identity of the provider and the team
responsible for each case will be clear to
all staff at all times.
Citizenship
• Interactions among team members are
respectful and collaborative at all times
• Frequent physical presence on the floor
will promote communication and
collaboration
High Efficiency
• Promote early discharge
• Team will work to minimize redundancy
• The provider with the highest level of
training should be caring for those patients
who need the highest level of care.
Evidence-Based Care
Care provided will be:
-- Based on the current best practices
-- Be standardized among all providers
-- Be informed by a rigorous CQI process
Safe Transitions
• Good communication at admission +
discharge
• All pts know how to care for themselves at dc
• Implement ReEngineered Discharge
Timely, High Quality Communication
• Frequent communication is needed for safe
provision of care
• Board rounds each AM+PM
• Nursing input at board + bedside rounds
• Communication with primary care team
• A dialogue among providers for each
change in plan or patient transfer
• Use of a standardized tool for handoffs
• Use language that patients understand
Maximize Continuity
• Communicating with PCP is a priority
• Information will flow smoothly from the
ambulatory providers to the unit and from the
unit to site of post hospital care.
Acceptable Case Load
• Safe patient care is possible only if there are
well rested providers responsible for a
reasonable number of patients
• Acceptable daily work load
Patient satisfaction
• Is a responsibility of all team members
• Is a key metric for quality
• Family members are our customers
Excellence in Education
• All team members have responsibility for the
education of residents, students and other
trainees.
• Nursing education is valued
• All providers are responsible for orienting and
teaching new members of the team about the
appropriate management and flow on the
floor.
Good Documentation
• There will be clear and consistent
documentation of all care delivered
• Will reconcile medications and care at all
times
• Health proxy and end of life care to be
documented at all times
QuEST
The Family Medicine HealthNet Inpatient service uses QuEST, the
BMC framework to measure outcomes
QuEST stands for:
Quality
Efficiency
Satisfaction
Total Revenue
QUALITY:
Mortality Analysis For Family Medicine
Attending Note Compliance for Non- Surgical Departments
All-Cause 30-Day Readmission Rate
7
EFFICIENCY:
Daily Workload by Care Team (Census Counted at 8am)
Weekly Average Discharge Time
Average Length of Stay Of Inpatient Discharges by Care Team
Average Length of Stay Of All BMC Admissions
Average Length of Stay Of Observation Discharges by Care Team
Monthly Length of Stay (Observed/Expected Ratio)
Average Length of Stay (Observed and Expected)
Percentage of Patients Admitted to E6W
Satisfaction:
HCAHPS Quarterly Patient Experience Trends: E6W
Communication Standards
Total Revenue:
Total Number of Patients Admitted and Discharged by Care Team
Monthly Total Number of Patients Admitted by Care Team
Average Total Admissions and Discharges by Day of Week
Percent of Admissions and Discharges in Observation Status by Care Team
Percent of All Admissions by Patient Class
Patients Lost
◦ HealtHNet Patients’ Admissions For All Services
◦ Monthly Percentage of HealthNet Patients’ Admissions to FM-HN
◦ HealthNet Patients’ Admissions by Health Center
◦ CCA Patients Lost
◦ HealthNet Patients Lost to Cardiology
Mortality Analysis for Family Medicine
Medical MS-DRG Mortality Analysis for Family Medicine
2.50
Mortality Rate (%)
2.00
1.50
FM-HN
continues to
have Om < Em
1.00
0.50
0.00
Q1 2013 (N= 625) Q2 2013 (N=583) Q3 2013 (N= 575) Q4 2013 (N=609) Q1 2014 (N=576) Q2 2014 (N=581) Q3 2014 (N=596)
Observed
Expected
Note: Discharges with non-viable neonates, or point of origin is hospice are excluded. Discharges from MICU to floor transfers are
included.
Q1 2013 (N=
625)
% ICU Cases
Source: UHC, Patient Outcomes Report
9.28
Q2 2013
(N=583)
Q3 2013 (N=
575)
10.46
12.17
Q4 2013
(N=609)
Q1 2014
(N=576)
11.82
Q2 2014
(N=581)
11.11
Q3 2014
(N=596)
10.15
9.06
Inpatient Mortality Index
Mortality Index for Family Medicine
1.00
0.90
0.80
BMC wants to achieve a
score of .77 or lower. FM
has always been
significantly lower than
that.
0.70
0.60
0.50
0.40
0.30
0.20
0.10
0.00
Q1 2013 (N= 625) Q2 2013 (N=583) Q3 2013 (N= 575) Q4 2013 (N=609) Q1 2014 (N=576) Q2 2014 (N=581) Q3 2014 (N=596)
Mortality O/E
Source: UHC, Patient Outcomes Report
Goal
Case Mix Index
Case Mix Index
1.45
CMI
1.35
1.25
1.15
1.05
0.95
Q1 2013
Q2 2013
Q3 2013
Q4 2013
Q1 2014
Quarter
FM CMI
FM Medicare CMI
Note: Discharges with non-viable neonates, or point of origin is hospice are excluded.
GIM CMI
GIM Medicare CMI
Q2 2014
Q3 2014
Attending Note Compliance for Non- Surgical Departments
FM-HN attending
continue to sign
charts according
to standard
Source: BMC Administration
All-Cause 30-Day Readmission Rate
30 Day All-Cause Readmission Rate for All Medical Services (May 2013-April 2014)
Readmission Rate
35%
30%
25%
20%
18%
13.70%
15%
10%
FM-HN has the
lowest readmission
rate among all the
medical services.
5%
0%
Medical Service
Note: The attribution is based on the mortality analysis logic
Source: BMC Administration- distributed at July 2014 Readmission meeting
Readmissions
All-Cause 30 Day Readmission
21.5
Readmission Rate (%)
19.5
17.5
15.5
13.5
11.5
9.5
Q1 2013
Q2 2013
Q3 2013
Q4 2013
Q1 2014
Quarter
FM
BMC
GIM
Q2 2014
Q3 2014
Daily Workload by Care Team (Census Counted At 8AM)
Daily Workload by Care Team in November
Average Daily Workload by are Team (at 8 am)
16
30
14
•
25
Number of Patients
Number of Patients
12
10
8
6
4
20
15
7
5
5
10
5
6
4
11
11
10
9
10
10
5
9
10
9
9
June
July
August
September
11
10
October
November
2
0
0
11/1 11/3 11/5 11/7 11/9 11/11 11/13 11/15 11/17 11/19 11/21 11/23 11/25 11/27 11/29
Month
Date
FM 1 8 AM Census
FM 2 (PA) 8 AM Census
CCA 8 AM Census
Source (both graphs): SDK Combined Census Report and confirmed with EPIC census on weekdays
FM 1
FM 2 (PA)
CCA
•
CCA volume
peaked for a day,
but then went
back to average
PA and FM team
have the same
average number
of patients
Weekly Average Discharge Time
Weekly Average Discharge Time
16:48
Discharge Time
16:19
FM-HN continues to
lead hospital in
average discharge
time.
15:50
15:21
14:52
14:24
13:55
13:26
Date
FM-HN
Entire Hospital
Source: Weekly hospital reports (From Jonathan Bunker)
Avg of H6E & H6W
Total Number of Patients Admitted and Discharged in
November by Care Team
Total Number of Patients Admitted and Discharged in November by Care Team
120
110
112
100
Number of Patients
88
85
For FM team
#admissions < # discharges
80
60
45
45
For PA team
#admissions < # discharges
40
For CCA team
#admissions= #discharges
20
0
FM 1
FM 2 (PA)
Care Team
Admissions
Discharges
Source: EPIC, Department of Medicine Admissions and DOM Discharges by Month report
CCA
Monthly Total Number of Patients Discharged by Care Team
•
Monthly Total Number of Patients Discharged by Care Team in
November
Number of Patients
300
45
250
47
200
50
45
36
3,500
128
150
106
89
94
112
100
50
FM-HN continues to
maintain a constant
volume about 8
admissions per day.
93
97
109
95
85
0
July
August
September
October
Month
FM 1
FM 2 (PA)
CCA
November
Observations
Discharges
Nox
Eve
2694
2094
1494
3,000
1119
2,500
2,000
1162
1161
1,500
1,000
500
Source: EPIC, DOM Discharges by Month report
Annual Volume
0
967
800
2028
300
222
206
387
AY12
AY13
260
198
0
AY14
Average Total Admissions and Discharges in November
by Day of Week
Average Total Admissions and Discharges in November by Day of Week
50
45
45
42
40
38
40
Number of Patients
35
35
37
•
42
36
32
32
28
30
•
25
23
25
30
20
•
15
10
5
0
Friday
Saturday
Sunday
Monday
Tuesday
Wednesday
Day of Week
Admissions
Discharges
Source: EPIC, Department of Medicine Admissions and DOM Discharges by Month Report
Thursday
Monday and Tuesday
had the highest number
of admissions
Monday and Tuesday
had the highest number
of discharges
Monday and Tuesday
were the busiest days in
November
Percent of November Admissions and Discharges in Observation
Status by Care Team
Monthly Percentage of Discharges in Observation
Status by Care Team
Percent of Admissions and Discharges In
Observation Status in November
40%
50%
37.6%
35.2%
35%
26.7%
25%
22.2%
Percentage
40%
30%
Percentage
The FM 1 team
admitted < patients in
obs status than it d/c
45%
35.5% 34.8%
35%
30%
25%
20%
15%
20%
10%
15%
July
August
September
October
Month
10%
FM 1
5%
0%
FM 1
FM 2 (PA)
CCA
Care Team
Admissions
Discharges
Source: EPIC, Department of Medicine Admissions and DOM Discharges by Month Report
FM 2 (PA)
CCA
November
The FM 9 (PA) and the
CCA teams admitted >
patients in obs status
than it d/c
Admissions in November by Patient Class
Admissions in November by Patient Class
70%
66.3%
60%
Percentage
50%
40%
33.7%
30%
20%
10%
0%
Inpatient
Observation
Patient Class
Source: EPIC, Department of Medicine Admissions
64.9% of all
admissions were in
inpatient status.
Average Length of Stay of Inpatient Discharges in by
Care Team (In Days)
4.95
5
4.05
3.85
4
3
3.28
2.62
5.2
4.9
4.6
4.3
4
3.7
3.4
3.1
2.8
2.5
June
July
August September October November
Month
2.17
FM 1
2
1
0
FM (n=53)
FM 2 (PA) (n=73)
CCA (n=35)
Care Team
Mean
Median
Source: EPIC (From DOM Discharges by Month report)
Average Length of Stay (In Days)
Average Length of Stay (In Days)
6
Average Length of Stay (In Days)
Average Length of Stay of Inpatient Discharges in
November by Care Team (In Days)
Monthly Length of Stay of Inpatient Discharges
by Care Team Based on the Mean (In Days)
FM 2 (PA)
CCA
Monthly Length of Stay of Inpatient Discharges by Care Team
Based on Median (In Days)
4.5
3.5
2.5
1.5
June
July
August
September
October
Month
FM 1
FM 2 (PA)
CCA
November
Based on Mean- CCA has
always had a longer ALOS and
the ALOS for CCA, and FM 1
increased since October
Based on Median- CCA
usually has a higher ALOS but
was similar to FM1 and FM 1
in August and September
ALOS for FM 1 increased since
October
Average Length of Stay of Inpatient admissions in October by
Day of The Week (In Days)
FROM DATE OF ADMISSION
FROM DATE OF DISCHARGE
Average Length of Stay of Inpatient Admissions in
November for FM-HN Service (In Days)
Average Length of Stay of Inpatient Discharges in
November for FM-HN Service (In Days)
5
5
6
5.5
4.5
3.5
3
3.4
2.9
2.9 2.8
2.5
2.6
3.4
3.3
2.9
2.4
3.3
2.6
2.1
2
1.5
4
3.8
4
3
5
4.7
5
3.6
ALOS (In Days)
ALOS (In Days)
4
People admitted on
Wednesday, Thursday
and Saturday have a
longer LOS and people
admitted on Sunday
and Monday have a
shorter LOS
2.4
2.8
4.2
2.6
2.1
2
3 2.8
1.8 2
1
1
0.5
0
Friday
0
Friday
Saturday
Sunday
Monday
Saturday
Tuesday Wednesday Thursday
Sunday
Monday
Day of Week
Day of Week
Mean
Mean
Median
Source: EPIC (From Department of Medicine Admissions and DOM Discharges by Month report)
Median
Tuesday Wednesday Thursday
People discharged on
Friday, Sunday, and
Monday longer LOS &
people discharged on
Saturday and Tuesday
have a shorter LOS
Average Length Of Stay by Day of Discharge in
September
ALOS by Day of Discharge in September
8.5
ALOS (In Days)
7.5
FM-HN ALOS is
always lower than
the ALOS for BMC
and
6.5
5.5
4.5
3.5
2.5
Sunday
Monday
Tuesday
BMC
Source: UHC, Patient Outcomes by Discharge Day
Wednesday
Day of Week
FM-HN
Thursday
GIM
Friday
Saturday
Average Length of Stay of Observation Discharges in
November by Care Team (In Hours)
30
25
29.5
28.47
27.04
24.5
22.6
21.9
20
15
Monthly Average Length of Stay of Observation
Discharges by Care Team Based on the Mean (In Hours)
50
45
40
35
30
25
20
Based on the Mean- the
ALOS for all three teams
decreased since October
June
July
August
September
October
November
Month
FM 1
FM 2 (PA)
CCA
10
Average Length of Stay of Observation Discharges by
Care Team Based on the Median (In Hours)
5
0
FM (n=32)
FM 2 (PA) (n=39)
CCA (n=10)
Care Team
Mean
Median
Source: EPIC , DOM Discharges by Month report
Average Length of Stay (In Hours)
Average Length of Stay (In Hours)
35
Average Length of Stay (In Hours)
Average Length of Stay of Observation Discharges in
October by Care Team (In Hours)
45
35
25
15
June
July
August
September
October
Month
FM 1
FM 2 (PA)
CCA
November
Based on the Median- the
ALOS for CCA and FM 2
decreased but slightly
increased for FM 1
Average Length of Stay of Observation Admissions in
October by Day of The Week (In Hours)
ALOS FROM ADMISSION DATE
ALOS FROM DISCHARGE DATE
Average Length of Stay of Observation Admissions in
November for FM-HN Service (In Hours)
Average Length of Stay of Observation Discharges in
November for FM-HN Service (In Hours)
60.7
40
60
35
30
40
30
26.8 26.3
37.9
34.4
29.6
36.4
25.9
22.2
19.3
20
23.5
29
21
21.4
ALOS (In Hours)
ALOS (In Hours)
50
34.7
31.9
31.2
25
27.1
23.7
23.922.7
25.1
22.2
23.7
26.9
24
28.2
18.6
20
15
10
10
5
0
Friday
Saturday
Sunday
Monday
Day of Week
Mean
Tuesday
Wednesday
Thursday
Admissions on Friday
and Sunday have a
longer LOS and
admissions on Thursday
and Monday have a
shorter LOS
0
Friday
Saturday
Median
Source: EPIC (From Department of Medicine Admissions and DOM Discharges by Month report)
Sunday
Monday
Day of Week
Mean
Median
Tuesday Wednesday Thursday
Discharges on
Monday and Tuesday
have a longer LOS and
discharges on Sunday,
Saturday and
Wednesday have a
shorter LOS
Comparing ALOS for Inpatient and Observation
Admissions in October: With and Without the CCA team
OBSERVATION ADMISSIONS
INPATIENT ADMISSIONS
Average Length of Stay (In Days)
4
3.9
3.9
3.8
3.7
3.6
3.6
3.5
3.4
3.3
3.2
3.1
Comparison of Average Length of Stay of
Observation Admissions in November
Average Length of Stay (In Hours)
Comparison of Average Length of Stay of Inpatient
Admissions in November
28.20
28.19
28.18
28.15
28.16
28.14
Obs ALOS is .04
hours less when
CCA is excluded
28.12
28.10
28.08
28.06
28.04
28.02
28.00
3
FM 1, FM 2 (PA), CCA
FM 1 & FM 2 (PA)
Care Teams
Note: ALOS is based on mean
Inpt ALOS is .3
hours less when
CCA is excluded
FM 1, FM 2 (PA), CCA
Care Team
FM 1 & FM 2 (PA)
Percentage of Patients Admitted to E6W
Percentage of Patients Admitted by FM-HN in
November by Floor
Percentage of Patients Admitted to E6W
100.0%
E6W
90.0%
88.7%
89.6%
84.0%
87.7%
83.0%
80.0%
E7E
E7N
70.0%
60.0%
50.0%
E7W
E8E
40.0%
30.0%
20.0%
E8W
87.7%
10.0%
0.0%
July
August
September
% admitted to E6W
Source: EPIC, Department of Medicine Admissions
October
Goal
November
In November FM-HN
admitted about 88%
of patients to E6W.
The percentage of
Admissions to E6W
has increased since
October
Percentage of Patients Discharged from E6W
Percentage of Patients Discharged From E6W
Percentage of Patients Discharged From FM-HN by
Floor
100%
90%
E6W
80%
70%
E7N
E7W
E8E
Percentage
E7E
60%
50%
40%
30%
20%
88.0%
E8W
10%
0%
November
December
Month
HCAHPS: Quarterly Patient Experience
Trends: BMC & E6W
Recommended Hospital
100
90
80
70
Rate (%)
60
E6W had a higher
percentage for
recommending the
hospital
50
40
30
20
10
0
2012 Q4
2013 Q1
2013 Q2 (n=159, 13) 2013 Q3 (n=158, 7) 2013 Q4 (n=291, 20) 2014 Q1 (n=431, 39) 2014 Q2 (n=422,44) 2014 Q3 (n=411, 36)
BMC
Note: The percentage presented in these graphs are the top box score percentages
Source: BMC Administration (From Inpatient Dashboard)
6W
Target
HCAHPS: Quarterly Patient Experience
Trends: BMC & E6W
Communication with Nurses
Communication with Doctors
100
100
90
90
80
80
70
60
Rate (%)
Rate (%)
70
50
40
60
E6W had a lower
score than BMC
for
communication
with nurses and
communication
with doctors
50
40
30
30
20
20
10
10
0
2012 Q4
2013 Q1
2013 Q2 2013 Q3 2013 Q4
(n=159, (n=158, 7) (n=291,
13)
20)
BMC
6W
2014 Q1 2014 Q2 2014 Q3
(n=431, (n=422,44) (n=411,
39)
36)
Target
Note: The percentage presented in these graphs are the top box score percentages
Source: BMC Administration (From Inpatient Dashboard)
0
2012 Q4
2013 Q1
2013 Q2 2013 Q3 2013 Q4 2014 Q1 2014 Q2 2014 Q3
(n=159, 13) (n=158, 7) (n=291, 20) (n=431, 39) (n=422,44) (n=411, 36)
BMC
6W
Target
HCAHPS: Quarterly Patient Experience
Trends: BMC & E6W
Response of Hospital Staff
Pain Management
100
100
90
90
80
80
70
60
Rate (%)
Rate (%)
70
50
40
60
E6W had a lower
score than BMC at
both responsible
of hospital staff
and pain
management
50
40
30
30
20
20
10
10
0
0
2012 Q4
2013 Q1
2013 Q2 2013 Q3 2013 Q4 2014 Q1 2014 Q2 2014 Q3
(n=159, 13) (n=158, 7) (n=291, 20) (n=431, 39) (n=422,44) (n=411, 36)
BMC
6W
Target
Note: The percentage presented in these graphs are the top box score percentages
Source: BMC Administration (From Inpatient Dashboard)
2012 Q4
2013 Q1
2013 Q2 2013 Q3 2013 Q4 2014 Q1 2014 Q2 2014 Q3
(n=159, 13) (n=158, 7) (n=291, 20) (n=431, 39) (n=422,44) (n=411, 36)
BMC
6W
Target
HCAHPS: Quarterly Patient Experience
Trends: BMC & E6W
Discharge Information
100
100
90
90
80
80
70
70
60
60
Rate (%)
Rate (%)
Communication about Medicines
50
40
50
40
30
30
20
20
10
10
0
2012 Q4
2013 Q1
2013 Q2
2013 Q3
2013 Q4
2014 Q1
2014 Q2
2014 Q3
(n=159, 13) (n=158, 7) (n=291, 20) (n=431, 39) (n=422,44) (n=411, 36)
BMC
6W
Target
Note: The percentage presented in these graphs are the top box score percentages
Source: BMC Administration (From Inpatient Dashboard)
E6W had a lower
score than BMC
for both
communication
about medicines
and discharge
information
0
2012 Q4
2013 Q1
2013 Q2
2013 Q3
2013 Q4
2014 Q1
2014 Q2
2014 Q3
(n=159, 13) (n=158, 7) (n=291, 20) (n=431, 39) (n=422,44) (n=411, 36)
BMC
6W
Target
HCAHPS: Quarterly Patient Experience
Trends: BMC & E6W
Quietness of Hospital Environment
100
100
90
90
80
80
70
70
60
60
Rate (%)
Rate (%)
Cleanliness of Hospital Environment
50
40
30
E6W had a slightly
higher score than
BMC for
cleanliness but
had a lower score
for quietness
50
40
30
20
20
10
10
0
2012 Q4
2013 Q1
2013 Q2 2013 Q3 2013 Q4 2014 Q1 2014 Q2 2014 Q3
(n=159, 13) (n=158, 7) (n=291, 20) (n=431, 39) (n=422,44) (n=411, 36)
BMC
6W
Target
Note: The percentage presented in these graphs are the top box score percentages
Source: BMC Administration (From Inpatient Dashboard)
0
2012 Q4
2013 Q1
2013 Q2
2013 Q3
2013 Q4
2014 Q1
2014 Q2
2014 Q3
(n=159, 13) (n=158, 7) (n=291, 20) (n=431, 39) (n=422,44) (n=411, 36)
BMC
6W
Target
Communication Standards
Percent of Patient's PCPs Contacted Upon Admisison and Discharge
100%
95%
96%
90%
80%
Percentage
70%
60%
50%
About 91% of
PCPs are
contacted upon
admission and
95% upon
discharge
40%
30%
20%
10%
0%
November '13 December '13 January '14 February '14
March '14
April '14
May '14
June '14
July '14
August '14
Month
% of PCPs contacted at Admission
Source: Communications Excel Tracking Sheet
Percentage of PCPs Contacted at Discharge
September
'14
October '14 November '14
Patients Lost
◦ HealtHNet Patients’ Admissions For All Services
◦ Monthly Percentage of HealthNet Patients’ Admissions to FM-HN
◦ HealthNet Patients’ Admissions by Health Center
◦ HealthNet Patients Lost to Cardiology
HealthNet Patients’ Admissions for ALL Services In October
HealthNet Patient's Admissions to FM-HN Service
70%
HealthNet Patient's Admissions in November
23.60%
2.20%
E Card Gen
9.60%
E Card CHF
Percentage
7.80%
60%
62%
57%
56%
August
September
57.1%
50%
40%
30%
20%
10%
Medical
Services
0%
October
November
Month
FM-HN
ED Obs Unit
57.10%
About 57% of HealthNet
patients were admitted
into the FM-HN Service in
November
Source: Individual SDK Inpatient and Observation admissions by Health Center report
Note: This graph includes patients with a PCP in Family Medicine Yawkey
Goal: ??
HealthNet Patients’ Admissions In October by Health Center
South Boston (44)
Greater Roslinale (1)
Yawkey ACC (52)
0.6%
6.8%
7.7%
6.8%
9.1%
19.2%
67.8%
77.3%
100%
Dorchester (36)
Geiger/Neponset (6)
Upham's Corner (39)
7.7%
11.1%
5.1%
Medical Teams
8.3%
33.3%
ER
20.5%
13.9%
66.7%
FM-HN loses the
least patients from
Geiger/Neponset,
Mattapan, South
Boston,and East
Boston (n>5)
66.7%
Source: Individual SDK Inpatient and Observation admissions by Health Center report
66.7%
FM-HN
Cardiology
HealthNet Patients’ Admissions In October by Health Center (Cont.)
East Boston (88)
Codman Square (39)
Mattapan (26)
7.7%
11.4%
11.5%
12.8%
7.7%
10.2%
62.5%
50.0%
53.8%
15.9%
25.6%
30.8%
Harvard St. (13)
Whittier St. (23)
17.4%
23.1%
4.3%
South End (1)
Manet (3)
33.3%
FM-HN loses the
most patients from
Whittier,
Roslindale, and
Harvard
Medical Teams
33.3%
ER
38.5%
47.8%
FM-HN
15.4%
Cardiology
30.4%
23.1%
33.3%
100.0%
Source: Individual SDK Inpatient and Observation admissions by Health Center report
APPENDIX
Variability in staffing patterns, operations, and processes results in
significant differences in discharge timing
Service
Cath Lab
Family Medicine – PA
EP
Ambulatory Surgery
Surgical Subspecialty
Neurology
Pediatric Surgery
Maternity
Family Medicine – Resident
Newborn
General Surgery
Medicine – Hospitalist
Gynecology
ED OBS
CHF
ID
Medicine – Resident
Oncology
General Neurology
General Cardiology
Renal
General Pediatrics
Geriatrics
Average
discharge time
1:22:41 PM
1:40:15 PM
1:41:27 PM
1:42:00 PM
2:20:02 PM
2:34:41 PM
2:40:00 PM
2:42:19 PM
2:46:47 PM
2:47:40 PM
2:48:13 PM
2:49:41 PM
3:05:39 PM
3:07:57 PM
3:15:15 PM
3:17:36 PM
3:22:59 PM
3:27:45 PM
3:31:36 PM
3:50:23 PM
4:01:25 PM
4:11:13 PM
4:12:30 PM
Average daily
discharges
1.2
4.9
0.5
2.0
10.1
0.4
0.6
8.0
3.7
5.7
8.7
6.4
1.7
4.9
1.9
2.9
11.0
2.1
2.4
3.1
2.8
5.2
3.3
Average discharge time: 2:58 PM
Advancing all these teams to
the current mean would save a
total of 25.6 bedded patienthours each day.
30 Day All-Cause Readmission by Service
Service
ENP HEM/ONC
ENP RENAL
E PULMONARY IP
E VASCULAR SURGERY
E CARDIOLOGY CHF
MP TEAM 3
MP TEAM 5
ENP 2
MP GERIATRIC IP
MP TEAM 6
MP TEAM 4
E TRANSPLANT
MP TEAM 2
MP TEAM 1
H MEDICU
ENP 1
E INTERNAL MED IP
H REHAB CENTER BMC
ENP FM
E CARDIOTHORACIC SURGERY
ENP PA
E CARDIOLOGY GENERAL
E CCU
Note: Services with less than 30 index cases are excluded.
Den Num
712 224
711 210
52
12
256
59
576 127
774 161
449
89
230
45
824 149
372
66
796 138
76
13
738 126
742 125
132
22
264
43
388
61
80
12
735 103
437
60
1042 143
682
93
327
39
30 Day All-Cause
Readmission Rate (%)
31.46%
29.54%
23.08%
23.05%
22.05%
20.80%
19.82%
19.57%
18.08%
17.74%
17.34%
17.11%
17.07%
16.85%
16.67%
16.29%
15.72%
15.00%
14.01%
13.73%
13.72%
13.64%
11.93%
Lack of clinical practice standardization across services
results in variable LOS for patients with similar DRGs …
LOS for Observation admissions with primary diagnosis of non-specific chest pain
Average hours
Source: SDK dataset, 8/1/2013-1/31/2014.