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Reducing Unnecessary Hospital Transfers

Reducing Unnecessary Hospital Transfers. Ellen Rychlik, RN, BSN Elderwood Health Care at Lakewood. Faculty Disclosures. Ellen Rychlik, RN, BSN has disclosed that she has no relevant financial relationship(s). Learning Objectives. By the end of the session, participants will be able to:

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Reducing Unnecessary Hospital Transfers

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  1. Reducing Unnecessary Hospital Transfers Ellen Rychlik, RN, BSN Elderwood Health Care at Lakewood

  2. Faculty Disclosures Ellen Rychlik, RN, BSN has disclosed that she has no relevant financial relationship(s).

  3. Learning Objectives By the end of the session, participants will be able to: • Identify the Risks Associated with Hospitalization of the Frail Elderly • Define Impact of Reduction in Unnecessary Hospital Transfers on Overall Resident/Family/Staff Satisfaction • Understand Strategical Elements of Process Improvement

  4. Facility Demographics • Elderwood Health Care at Lakewood • Hamburg, New York • 166 Beds • Privately Owned

  5. Reducing Unnecessary Hospitalization Risks Associated with Hospitalization • Increased delirium • Sleep deprivation • Immobility • Dehydration • Falls • Malnutrition • Pressure Ulcers

  6. Improving Quality of Life • Decrease interruption of daily care to the resident • Increase treatment options in-house • Maintain function ability

  7. Data Collection and Analysis Hospitalization Tracking Record • Transferring Physician • Admission to Hospital • Time of Transfer • Symptomatollogy Necessitating Hospital Transfer • Admitting Diagnosis

  8. Hospitalization Tracking Record • Identification of Case Review Strategical Opportunities • Improved Advanced Care Planning • Identification of Educational Opportunities for Future Staff Development • Readily Identifies Causes and Trends that Result in Residents Being Transferred to the Hospital

  9. Goals of the LTC Industry • Maximize Function Ability • Maintain Skin Integrity • Minimize Weight Loss • Prevent Immobility • Maintain Quality of Life

  10. Daily Acuity Reporting Tool • Reviewed daily by the IDT • Uses the acronym PARED with: P – Identifying the (P)roblem A – Choosing an appropriate (A)ction R – Monitoring of residents (R)esponse E – Evaluating the (E)ffectiveness of the action or intervention in treatment of the problem D – (D)iagnosticTesting – monitoring of pertinent lab values, radiology reports, ECG,etc.

  11. Elderwood Health Care at Lakewood Daily Acuity Reporting Tool Days Evenings Nights Admission/Identified Issue(Problem) Rm #/Name 311 W TPR BP O2sat I O TPR BP O2sat I O TPR BP O2sat P R leg ulcer App / App 2/13 LBM 2/13 Contact Prec for Poss.. C. Diff P ? R leg P ? R leg P ? R leg LBM LBM LBM A 2/5 Cipro ( R leg Cellulitis) completed 2/11 A A A R 2/14 stool c diff-pend R R R 2/16 RLE Ven. Doppler E E E E D 1/6 WBC ? 3.4(3.9), Hgb 11.4(10.8) D D D 1/6 BMP WNL Physician/Surgeon Rm #/Name 312 TPR BP O2sat I O TPR BP O2sat I O TPR BP O2sat P 1/29 Contact Prec for C. Diff App / App ? BUN P sx dehydr P sx dehydr P sx dehydr resp sx resp sx resp sx A 1/22 bumex bid,lasix 2/13 Flagyl done A lungs A lungs A lungs 2/3 vanco (til 2/24) GI sx GI sx GI sx R R pain R pain R pain 1/23 US RUQ:kidney cysts cardiac sx cardiac sx cardiac sx E E E E CBC,BMP T, Th G L D 2/12 CBC--wnl 1/27 BNP 253,250 D Vanco D G L D G L 2/12 BUN 33(wnl) 2/12 Alk. Phos. 210 Physician/Surgeon Rm #/Name 313 D I O I O TPR BP O2sat TPR BP O2sat TPR BP O2sat P ? BUN App / App P sx dehyd P sx dehyd P sx dehyd A HP 240 q4h A A A R R behavior R behavior R E E E E BMP q2 wks D D D D 1/23 BUN 42 (29,36) Physician/Surgeon KEY: P roblem (VS,Symptoms,Assessment) A ction (MD Orders/Nurse Follow Thru) R esponse (Patient Response) E valuation(Re-assesment/Need for N.O.'s) D iagnostic Testing (Results/Repeat Date) Unit 1 2 3 Team 1 2 3 4 February , 2009

  12. Outcomes • Resident Outcomes Decreased Hospitalizations = Increased Satisfaction

  13. Outcomes • Regulatory Outcomes DART = Elimination of Clinical/Delay in Treatment Deficiencies • Quality of Service Experts in Gerontology Treating Residents at Home

  14. Outcomes Enhanced Staff Performance Exciting and Rewarding Environment with Coinciding Reduction in Turnover Effect on Staff’s Routine Work They are Given the Tools they Need to Work More Efficiently (Actionable Information) Improved Organization & Management Structure

  15. Outcomes Financial OutcomesKeeping the Cost Down by Avoiding the Costly Risks Associated with Hospitalizations

  16. Improved Quality of Life for the Resident

  17. Questions

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