Transcript Allen_Panel2011

Evidence Based Medicine
Congestive Heart Failure Initiative
Allen Hospital, New
York Presbyterian
NYAM review session
August 10th 2011
Evidence Based Medicine Approach
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Project began September 2009
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Learned the Basic Skills and Principles of EBM
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How to ask a question
How to perform a relevant search
Evaluation and Interpreting articles
Principles of guideline evaluation and development
#1 Choose a project that counts!
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Who are your customers?
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Doctors: Clinical benefit
Hospital: Financial benefit
Patients: Improved care
#2 Involve everyone that matters!
Multidisiplinary Team
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ER: Dr. Leslie Miller, Dr.
Peter Wyer
Hospitalist: Dr. Beth Barron,
Dr. Zorica Stojanovic, Dr.
Eugene Wong
Cardiology: Dr. Gerald
Neuberg, Karen Stugensky,
PA
Quality: Avi Fishman, Mary
Ellen Hickman
Librarian: John Oliver
IT: Amalga: Niloo Shobhani
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Social Work: Eileen
Kornfield
Nutrition: Susan Fulton
Care coordination: Donna
Tingling-Solanges, Doug
Morton
Nursing: Kelly Maydon, Alan
Levine, Mitzy Placencia
Patient Education: Jody
Scopa Goldman
Administration: Michael
Fosina VP – Executive
Director of Allen Hospital
# 3 Know what your problems is
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Internal scan – Who are our patients? (chart review,
patient calls, staff survey)
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Admitted from? Discharged to? Services?
Insurance? Private physician?
When and if follow up scheduled?
What medications d/c home on?
Smoking? Diabetes? Other co-morbidities?
What do the patients think about our care?
External scan – What is in the literature?
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Home care, Health literacy, Medications, Language barriers,
Patient education, Economic, Prediction rules, and Cardiology
evaluation
#4 What will work for Allen?
Knowledge Translation
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Group reviewed the evidence, reviewed
external guidelines and our internal reviews
Agreed that we would focus on education
and the transition of care from hospital to
outpatient primary care doctor
Spanish language capabilities a must
Project began 11/15
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Mitzy Placencia, CHF RN
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Inpatient education (Patient education handbook)
Core measures evaluation
Outpatient phone calls until seen by primary
Trouble shooting (medications, f/u visits)
Scales
Nutrition consults
CHF Education and Follow Up Pathway
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Day 1 Patient is admitted through the ED
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Patient admission notes are screened for appropriateness
of education.
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Patient educated on:
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What is CHF
Daily weights
Sodium and Fluid Restrictions
When to call the physician
CHF Pathway Cont.
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Day 2
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Review sodium and fluid restrictions
Review medications with the patient and family
Day 3
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Review discharge teaching:
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What to do if you notice an increase in symptoms
When to call the physician and when to come to ED.
After Discharge…
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The patient is called at home 2-3 times a week for
one month
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Medications reconciled
Symptoms assessed
Family members and Home Attendants educated also
Troubleshooting:
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Earlier appointments, medications refilled, diuretics doses
increased if necessary and more…
Education continues!
Collaborations With Other Healthcare
Professionals
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CHF classes held on a weekly basis with
nutrition.
Weekly meetings with VNSNY
Phone calls to the field nurse of various
homecare agencies to discuss the patients’
progress and status.
#5 Measure your successes and be
willing to change/evolve
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Volume
Impact of early follow up
Issues identified with readmitted patients
Impact of keeping in touch
CHF RN Coordinator monthly patients
volume (11/15/10 -7/31/11 )
50
45
40
35
30
25
Number of patients
20
15
10
5
0
NOVEM
JAN
MAR
MAY
JULY
Impact of early follow up
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All 198 patients had
follow up appointment
scheduled before
discharge:
105
< 7 days: 111 patients
(56%)
> 7 days: 87 patient
(44%)
45
85
65
25
5
f/u<7d
f/u>7d
Impact of early follow up on
readmissions
105
8 patients (9.2%)% with
f/u<7 readmitted
23 patients (20.7%) with
f/u>7d readmitted
85
65
45
25
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f/u<7d
f/u>7d
Impact of keeping in touch
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Post discharge phone call attempted on all
patients seen in hospital.
Only 7 of them were unreachable
5 out of 7 were readmitted
CHF 30 Day Readmission Measures
Allen
Hospital
Q1 2010
2010
Q1 2011
2011
(JanMay)
Readmis
sions
27.5%
28.36%
18.31%
20.16%
Allen Hospital: 30 day CHF Readmission Rate
Jan 2009 - May 2011
2009
60%
2010
2011
50%
Readmission Rate
40%
30%
20%
10%
0%
Jan
Feb
Mar
Apr
Source: TSI ; Data current, as of 7/20/2011
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Zorica’s lessons learned slides
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We offered one size fits all (education and
transition of care) approach…
and added
Many different interventions were needed
for each individual patients.
Positive impact
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NYP impact
Allen impact
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Future projects?