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Hospital Story

Hospital Story. Kristen van Bergen-Buteau, CPHQ Assistant Director, Quality Services Littleton Regional Hospital New Hampshire. About Us. Located in Littleton NH since 1907 25-bed Critical Access Hospital General Med/Surg & Intensive Care Units Agnes Norris Family Birth Center

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Hospital Story

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  1. Hospital Story Kristen van Bergen-Buteau, CPHQ Assistant Director, Quality Services Littleton Regional Hospital New Hampshire

  2. About Us • Located in Littleton NH since 1907 • 25-bed Critical Access Hospital • General Med/Surg & Intensive Care Units • Agnes Norris Family Birth Center • 24 hour Emergency Department with Level III Trauma Center • Surgical services, including orthopedics joint replacement excellence program, endoscopy and • Outpatient ancillary services include new fixed MRI, 64-slice CT, nuclear medicine & clinical/pathology lab services for both patients and as a reference lab for facilities throughout NH & VT • Outpatient Sleep & Oncology/Infusion Centers • 11 provider-based primary and specialty care practices on campus (26 employed practitioners) • 111 members of the Medical Staff

  3. What Did We Test? • Post discharge follow-up calls • Follow-up appointments made prior to discharge • Inpatient interviews of patients during readmission • Electronic access to provider records for admission/discharge notification • Immediate dictation & distribution of Discharge Summaries at time of discharge • Medication Reconciliation list sent with Discharge Summary

  4. What Have We Learned So Far? • Improvements in process don’t necessarily mean immediate improvements in readmission rates! • “Hot Spotters” exist, but we can’t reduce their utilization until we establish cross-continuum plans • No significant trends in readmissions by diagnosis, but opportunities are similar regardless of primary reason for utilization

  5. What Barriers Did We Encounter? • Patient “non-compliance” • “Non-compatible” medical records systems • 30-day rule • Medications • “Different” needs for receiving providers • Lack of a social safety net

  6. How Did We Overcome These Barriers? • Patient “non-compliance” • It’s a misnomer! We just need to ask the right questions to identify their barriers • “Non-compatible” medical records systems • Look closer, and think outside the box (but within the rules) • 30-day rule • It’s okay to dictate and sign SOONER! • Medications • Electronic Reconciliation forms in paper format • Polypharmacy & cross-reactions • “Different” needs for receiving providers • Not really – it’s all about communication & shared vocabulary • Lack of a social safety net • “Hot Spotters” have many socioeconomic barriers in a rural area with few resources

  7. How Are We Doing Now?

  8. How Are We Doing Now?

  9. How Are We Doing Now?

  10. How Are We Doing Now?

  11. What Can Others Learn From Our Journey? • Start collaborating across the continuum – NOW! • Multiagency meetings to identify collective opportunities (LTC, ALF, HH, PCT, etc) • Task forces focused on specific transitions in care and on specific “Hot Spotters” • Be willing to use LOTS of Rapid Cycle Improvement – every form & script is a draft and that’s okay • Think outside the silos – there ARE resources we’re not tapping in rural areas, but most are NOT health-care related

  12. Insist on cleaning up internal processes before any other cross-continuum work can begin – “Neat” and “Sterile” are two very different standards!! Get bogged down in data Fix the whole system at one time Do Not Try This At Home (Suggestions for What Not to Do…)

  13. Multi-agency Interdisciplinary Care Plans for “Hot Spotters” Task Forces for specific transitions in care Follow-up calls and appointments for Emergency Department patients New Patient Education/Discharge Instruction product Sooner post-discharge appointments (within 7 days) and more same-day appointments for high risk patients Clearer communication about who can implement a treatment plan (Admission vs. return to NH or HH) Earlier PCT/Hospice intervention Paramedic home visits Next Tests of Change

  14. Summary: We’re only just getting started Collaboration is key to success Patients and ALL of their providers need to be engaged Teach Back

  15. Questions? Teach Back

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