Transcript Family Medicine Boston Health Net Inpatient

Family Medicine HealthNet
Inpatient Service
QUALITY REPORT AND UNIT DASHBOARD: BMC E6W
QUEST: (QUALITY, EFFICIENCY, SATISFACTION AND TOTAL REVENUE)
April 2015
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
2.00
1.80
Mortality Rate (%)
1.60
1.40
1.20
FM-HN
continues to
have Om < Em
1.00
0.80
0.60
0.40
0.20
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=574) Q3 2014 (N=590) Q4 2014 (N=644)
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
Q2 2013
(N=583)
9.28
Source: UHC, Patient Outcomes Report
Q3 2013 (N=
575)
10.46
Q4 2013
(N=609)
12.17
Q1 2014
(N=576)
11.82
Q2 2014
(N=581)
11.11
Q3 2014
(N=596)
9.93
Q4 2014
(N=644)
8.81
10.40
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)
Mortality O/E
Source: UHC, Patient Outcomes Report
Q1 2014
(N=576)
Goal
Q2 2014
(N=581)
Q3 2014
(N=596)
Q4 2014
(N=644)
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
Q2 2014
Q3 2014
Q4 2014
Quarter
FM CMI
FM Medicare CMI
GIM CMI
GIM Medicare CMI
Note: Discharges with non-viable neonates, or point of origin is hospice are excluded.
CCA patients are included in the denominator but not the numerator because CCA patients are not billed for therefore, the CMI for FM may be inaccurate.
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
All-Cause 30 Day
readmission for FMHN is significantly
lower than
readmission rate for
GIM, but higher
than readmission
rate for BMC
17.5
15.5
13.5
11.5
9.5
Q1 2013
Q2 2013
Q3 2013
Q4 2013
Q1 2014
Quarter
FM
BMC
Source: UHC; All-Cause Readmissions by Discharge Quarter
GIM
Q2 2014
Q3 2014
Q4 2014
Daily Workload by Care Team (Census Counted At 8AM)
Average Daily Workload by are Team
(at 8 am)
18
16
14
12
10
8
6
4
2
Number of Patients
Number of Patients
Daily Workload by Care Team in March
3/1 3/3 3/5 3/7 3/9 3/11 3/13 3/15 3/17 3/19 3/21 3/23 3/25 3/27 3/29 3/31
35
30
25
20
15
10
5
0
6
5
7
6
5
FM 2 (PA) 8 AM Census
6
11
10
10
10
4
13
9
10
11
10
9
9
10
9
9
11
10
10
10
12
10
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
March
Date
FM 1 8 AM Census
5
8
11
Month
CCA 8 AM Census
FM 1
FM 2 (PA)
CCA
•
Source (both graphs): SDK Combined Census Report and confirmed with EPIC census on weekdays
•
CCA volume picked up
and peaked at the end
of the month
The average number
of patient per Care
Team was relatively
similar
Weekly Average Discharge Time
Weekly Average Discharge Time
16:48
FM-HN continues to
lead hospital in
average discharge
time.
Discharge Time
16:19
15:50
15:21
14:52
14:24
13:55
13:26
Date
FM-HN
Source: Weekly hospital reports (From Jonathan Bunker)
Entire Hospital
Avg of H6E & H6W
Total Number of Patients Admitted and Discharged in March
by Care Team
Total Number of Patients Admitted and Discharged in March by Care Team
120
107
105
Number of Patients
100
95
91
For FM team
#admissions > # discharges
80
56
60
50
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
300
45
Number of Patients
250
47
200
50
48
45
36
52
41
50
128
150
106
89
94
107
112
97
100
93
97
95
109
85
92
Nov-14
Dec-14
82
94
Jan-15
Feb-15
105
0
Jul-14
Aug-14
Sep-14
Oct-14
Month
FM 1
FM 2 (PA)
CCA
3,500
95
100
50
FM-HN continues to
maintain a constant
volume about 8
admissions per day.
Mar-15
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
Total Admissions and Discharges in February by Day of Week
Total Admissions and Discharges in March by Day of Week
60
52
•
Wednesday and Monday
had the highest number
of admissions
•
Tuesday and Monday
had the highest number
of discharges
•
Monday was the busiest
day in March
Number of Patients
50
40
38
34 34
28
30
41 41
35
43
38
30
29
32
29
20
10
0
Friday
Saturday
Sunday
Monday
Tuesday
Wednesday
Thursday
Day of Week
Admissions
Discharges
Source: EPIC, Department of Medicine Admissions and DOM Discharges by Month Report
Percent of March 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 by Care Team
45.0%
40.0%
60.0%
41.8% 41.1%
36.4% 37.1%
36.0%
50.0%
26.8%
25.0%
20.0%
Percentage
Percentage
35.0%
30.0%
•
40.0%
30.0%
•
20.0%
15.0%
10.0%
10.0%
0.0%
5.0%
Jul-14
0.0%
FM 1
FM 2 (PA)
Aug-14 Sep-14
Oct-14 Nov-14 Dec-14
Month
CCA
Care Team
FM 1
Admissions
•
Discharges
Source: EPIC, Department of Medicine Admissions and DOM Discharges by Month Report
FM 2 (PA)
CCA
Jan-15
Feb-15 Mar-15
FM 1 and CCA
admitted < patients
in Obs status than
they d/c
FM 2 (PA) admitted >
patients in Obs
status than they d/c
The % of d/c in Obs
status incrased for all
three teams
Admissions in March by Patient Class
Admissions in March by Patient Class
100.0%
90.0%
80.0%
Percentage
70.0%
63.8%
60.0%
50.0%
36.2%
40.0%
30.0%
20.0%
10.0%
0.0%
Inpatient
Observation
Patient Class
Source: EPIC, Department of Medicine Admissions
63.8% of all
admissions were in
inpatient status.
Average Length of Stay of Inpatient Discharges by
Care Team (In Days)
5.9
6
5
ALOS (In Days)
5
4
3
4.4
7
ALOS (In Days)
ALOS of Inpatient Discharges in March by
Care Team (In Days)
Monthly ALOS of Inpatient Discharged Based on
Mean (In Days)
6
5
4
3
2
3.5
3.1
2.8
Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15
Month
2
FM 1
1
FM 2 (PA)
CCA
Monthly ALOS of Inpatient Discharged Based on Median
(In Days)
FM (n=68)
FM 2 (PA) (n=53
CCA (n=41
Care Team
Mean
Median
ALOS (In Days)
0
5.5
4.5
3.5
2.5
1.5
Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15
Month
Source: EPIC (From DOM Discharges by Month report)
FM 1
FM 2 (PA)
CCA
Based on Mean- the ALOS for
all three teams decreased
since Jan.
Based on Median- the ALOS
for FM 1 and 2 decreased and
increased for CCA Since Feb.
Average Length of Stay of Inpatient admissions in
February by Day of The Week (In Days)
FROM DATE OF ADMISSION
FROM DATE OF DISCHARGE
6.0
6
4.9
4.6
4
4.2
4.1
3.9
4
4.4 4.3
3.7
3.2
2.7
3
2.9
2.6
2
4.0
0.0
Mon
Tue
Wed
Thu
4.3
3.7
3.0
2.9
Fri
Day of Week
Mean
3.2
3.0
2.5
2.3
2.0
0
Sun
4.9
3.8
2.0
1.0
Sat
4.9
3.0
1
Fri
5.4
5.3
5.0
ALOS (In Days)
ALOS (In Days)
5
4.9
Median: Pts admitted Tues
and Wed have longer LOS
& pts admitted Sun and
Mon have shorter LOS
ALOS of Inpatient Discharges in March for FM-HN
Service (In Days)
ALOS of Inpatient Discharges in March for FM-HN Service
(In Days)
Mean: pts admitted Fri &
Tue have a longer LOS &
pts admitted Mon and
Thurs have shorter LOS
Median
Source: EPIC (From Department of Medicine Admissions and DOM Discharges by Month report)
Sat
Sun
Mon
Day of Week
Mean
Median
Tue
Wed
Thu
Mean: pts d/c on Sun and
Mon had a longer LOS &
pts d/c Sat and Wed have
shorter LOS
Median: pts d/c on Mon
and Thurs had a longer
LOS and pts d/c on Fri
and Sat had a shorter LOS
Average Length Of Stay by Day of Discharge in February
ALOS by Discharge Day in February
8.00
7.50
7.00
ALOS (In Days)
6.50
Patients admitted to
FM-HN on Tues and
Thurs-Sun have a
shorter LOS than
patients admitted to
GIM on those days
6.00
5.50
5.00
4.50
4.00
3.50
3.00
Sun
Mon
Tue
Wed
Thu
Day of Week
BMC
Source: UHC, Patient Outcomes by Discharge Day
FM-HN
GIM
Fri
Sat
Average Length of Stay of Observation Discharges by
Care Team (In Hours)
ALOS of Observation Discharges in March by
Care Team (In Hours)
45
38.3
40
39.1
30
28.4
25
20
50
45
40
35
30
25
20
Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15
25.1
Month
21.4
18.4
FM 1
15
10
FM 2 (PA)
CCA
Monthly ALOS of Observation Discharges Based
on Median (In Hours)
5
0
FM (n=39)
FM 2 (PA) (n=38)
CCA (n=15)
Care Team
Mean
Median
ALOS (In Hours)
ALOS (In Hours)
35
ALOS (In Hours)
Monthly ALOS of Observation Discharges Based on Mean
(In Hours)
45
35
25
15
Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15
Month
Source: EPIC , DOM Discharges by Month report
FM 1
FM 2 (PA)
CCA
Based on both the mean
and the median, the ALOS
for FM 1 and FM 2
decreased since Feb and
increased for CCA
Average Length of Stay of Observation Admissions in
February by Day of The Week (In Hours)
ALOS FROM ADMISSION DATE
ALOS FROM DISCHARGE DATE
ALOS of Observation Discharges in March for FMHN Service (In Hours)
ALOS of Observation Discharges in March for FMHN Service (In Hours)
40
35
27.7
28.7
27.7
20.5
19.5
19.1
21.3
33.1
32.1
21
16.4
15
10
24.8
25
28.2
25.8
18.9
18.2
20
• Based on the median, pts
admitted Sat and Sun have a
longer LOS and pts admitted
on Mon and Tue have a
shorter LOS
33.2
32.3
29.7
30
24.9
25
20
32
31.7
ALOS (In Hours)
ALOS (In Hours)
30
33.8
33
35
• Based on the mean, pts
admitted on Sat and Sun have
a longer LOS and pts admitted
on Fri and Mon have a shorter
LOS
27.9
20
22.1
21.1
15
• Based on the mean, pts d/c
on Fri and Mon have a longer
LOS and pts d/c on Thurs and
Sat have a shorter LOS
10
5
5
0
0
Fri
Sat
Sun
Mon
Tue
Wed
Thu
Fri
Sat
Day of Week
Mean
Median
Source: EPIC (From Department of Medicine Admissions and DOM Discharges by Month report)
Sun
Mon
Day of Week
Mean
Median
Tue
Wed
Thu
• Based on the median, pts d/c
on Mon and Fri have longer
LOS and pts d/c Sat and Tues
have shorter LOS
Comparing ALOS for Inpatient and Observation Admissions in
February: With and Without the CCA Team
INPATIENT ADMISSIONS
Comparison of ALOS of Inpatient Discharges in March
(In Days)
Comparison of ALOS of Observation Discharges in
March (In Hours)
5
35
4.3
ALOS (In Days)
4
3.5
30
3.9
3.2
2.9
3
2.5
2
1.5
1
ALOS (In Hours)
4.5
Mean:
Inpt ALOS is .4 days less
when CCA is excluded
OBSERVATION ADMISSIONS
25
28.9
26.7
21.4
20.5
20
15
Mean:
Obs ALOS is 2.2 hours
less when CCA is
excluded
10
5
0.5
0
0
FM 1, FM 2 (PA), CCA
FM 1 & FM 2 (PA)
Care Team
Mean
Source: EPIC; Discharges
Median
Median:
Inpt ALOS is .3 days less
when CCA is excluded
FM 1, FM 2 (PA), CCA
FM 1 & FM 2 (PA)
Care Teams
Mean
Median
Median:
OBS ALOS is .9 hours
hours when CCA is
excluded
Percentage of Patients Admitted to E6W
Percentage of Patients Admitted to E6W
Location of Patients Admitted to FM-HN in
March
1.2%
3.1%
4.3%
100%
80%
E6W
6.7%
E7E
E7N
70%
Percentage
2.0%
83.1%
90%
E7W
E8E
60%
50%
40%
30%
20%
10%
83.1%
E8W
0%
Jul-14
Aug-14 Sep-14
Oct-14 Nov-14 Dec-14
Month
Source: EPIC, Department of Medicine Admissions
Jan-15
Feb-15 Mar-15
In February FM-HN
admitted 83.1% of
patients to E6W. The
percentage of
Admissions to E6W
has increased since
February
Percentage of Patients Discharged from E6W
Percentage of Patients Discharged from
E6W
Location of Patients Discharged From FM-HN in March
100%
83.20%
E6W
1.6%
4.4%
2.8%
E7E
1.2%
90%
80%
70%
E7N
6.8%
E7W
60%
50%
40%
E8E
E8W
83.2%
30%
20%
10%
0%
Nov-14
Dec-14
Jan-15
Series1
Feb-15
Series2
Mar-15
In February FM-HN
discharged about
83.2% of patients
from E6W. The
percentage of
discharges from E6W
has increased sin
February
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
96%
100%
98%
90%
80%
About 96% of
PCPs are
contacted upon
admission and
98% upon
discharge
Percentage
70%
60%
50%
40%
30%
20%
10%
0%
Nov '13
Dec '13
Jan '14
Feb '14
Mar '14
Apr '14
May '14
Jun '14
Jul '14
Aug '14
Sep '14
Oct '14
Month
Source: Communications Excel Tracking Sheet
% of PCPs contacted at Admission
Percentage of PCPs Contacted at Discharge
Nov '14
Dec '14
Jan '15
Feb '15
Mar'15
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 February
Monthly HealthNet Admissions
100%
HealthNet Patient's Admissions in March
90%
80%
1.5%
70%
ED Obs Unit
15.5%
Medical Services
53.9%
Percentage
FM-HN
9.1%
E Card Gen
20.0%
E Card CHF
60%
50%
40%
30%
57%
56%
Aug-14
Sep-14
62%
57%
60%
57%
54%
54%
Oct-14
Nov-14
Dec-14
Jan-15
Feb-15
Mar-15
20%
10%
0%
Month
FM-HN
Source: Individual SDK Inpatient and Observation admissions by Health Center report
Note: This graph includes patients with a PCP in Family Medicine Yawkey
ED Obs Unit
Medical Services
E Card Gen
E card CHF
About 54% of HealthNet
patients were admitted
into the FM-HN Service
in March
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.
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