Texas
Regional Template: Readmissions
Workgroup
Organization: Texas Children’s Hospital
1
The Texas Regional Hospitals
•Baylor Scott & White McLane Children’s Medical Center
•Children’s Health, Children’s Medical Center
•Children’s Memorial Hermann Hospital
•Cook Children’s Medical Center
•Covenant Children’s
•Dell Children’s Medical Center of Central Texas
•Driscoll Children’s Hospital
•Medical City Children’s Hospital
•Texas Children’s Hospital (Houston)
•The Children’s Hospital of San Antonio
2
Readmissions Bundle Elements
Element
Discharge instructions contain a plan on
potential problems and what to do if they
arise (as in who to call)
Schedule follow-up medical and post
discharge tests/labs appointments prior to
discharge
Provide feedback to clinicians on any
readmission
Identify high risk populations
Post-discharge follow-up call to reinforce
discharge instructions with a standardize
script
Language Assistance
(Not required by SPS bundle. Specific to TCH.)
3
Details
• Discharge instructions contain a plan including:
o Accurate medication list and instructions
o How to recognize and respond to the patient’s clinical changes
o Escalation contact relevant to the situation
• For weekday discharges: Patient’s 1st follow up appointment scheduled prior to
discharge including an exact time, date, location, and care provider.
• For weekend and holiday discharges: The patient’s discharge instruction to list
the follow up appointment provider, their phone number, and the time frame for
the appointment
• Timely notification to discharging physicians of the readmission
• In a non-judgmental fashion, invite the discharging physician to review the case
and make recommendations, if appropriate, as to how this readmission might have
been prevented.
• Each hospital will identify a population at high risk for readmission.
• Develop and implement readmission risk mitigation plan for the identified patient
population.
• Measure adherence to the plan at the time of discharge.
• A follow up phone call within 72 hours of discharge using a standard script and
providing direct access to a medical professional, if needed.
• A second attempts on a different day should be made if the first call is
unsuccessful.
• Parents not wanting to talk is considered a successful call.
• Ascertain need for and obtain language assistance for discharge instructions.
Readmission Data Collection Methods
• Population
– Population list is generated by QlikView app
 Numerator: Number of readmissions that occur within 7 days of discharge (<=7)
 Denominator: Total number of discharged patients during time period
 Inclusion: All patients are included who are defined as inpatient or under observation at the
hospital
 Exclusion: Readmitted for planned scheduled procedures (i.e., psychiatric and rehab units for
scheduled procedures or for planned and scheduled chemotherapy
• Trigger Tools –We are looking at how to leverage Epic
to trigger bundle use
• Chart Review Tools
 20 randomized charts from all discharges
 Captured on Excel worksheet
4
Readmission Interventions
Goal: 2.78%
Cycle 6: Data Transparency
• Readmission reports by Service
• Bundle compliance to Units
A P
S D
Cycle 5: Identify High Risk
Population
• Aligned with organization’s strategic plan
Cycle 4: Medication Education & Reconciliation Pilot
•
•
Clarification of Rx – Nursing or Pharmacy?
Roles and Responsibilities clarification
Cycle 3: Create Readmission Notification & Survey
A P
S D
•
•
•
•
Created HAC Readmission e-mail account
Pilot PHM Survey
Modified survey
Expand to other Services
Cycle 2: Survey Services for Existing Phone Calls Made Post Discharge
•
•
•
Pilot making post discharge calls at one campus
Determine capability of existing resources, including StarKids
Expand to other campuses and focus on another high risk group
Cycle 1: Create Post-Discharge Appointment Order in Epic
•
•
•
5
Discharging provider enters F/U order with Service needed and timeframe for appt
Central Scheduling can make appt prior to discharge
Report created to track use of Discharge Order, appts made, and if patient completed appt
Readmission Rate
(7-Day)
Aug 14
Sep 14
Oct 14
Nov 14
Dec 14
Jan 15
Feb 15
Mar 15
Apr 15
May 15
Jun 15
Jul 15
Aug 15
Sep 15
Oct 15
Nov 15
Dec 15
Jan 16
Feb 16
Mar 16
Apr 16
May 16
Jun 16
Jul 16
Aug 16
Sept 16
Oct 16
# of
Readmission
Events
75
75
86
65
70
70
60
61
61
76
74
58
68
41
60
79
41
42
39
51
83
82
70
72
66
87
64
Discharges
1717
2316 2293
2194 2410 2273
2189
2413 2165 2203 2153 2213 1598
2061
2282 1949 1854
1842
1802 2040 2386 2358 2333 2294 2338 2379 2350
Monthly
Hospital Rate
4.37
3.24
2.96
2.74
2.53 2.82 3.45 3.44 2.62
1.99
2.63 4.05 2.21
2.28
2.16
6
3.75
2.90
3.08
4.26
2.50
3.48
3.48
3.00
3.14 2.82 3.66 2.72
Readmission Best Practice
Recommendations
• In collaboration with SPS Executive Leadership
at TCH, aligned with TCH’s strategic goal to
manage STAR Kids
– High Risk Population identified
• Data Transparency
– Provide readmission reports by Service
– Provide feedback to Units on bundle compliance
7
Readmission Requests for Assistance
• Information Sharing
– Challenges
• Bundle trigger in Epic
• Post discharge follow-up phone calls
– High Volume, limited resources
– Other organizations’ successes and failures?
8
QUESTIONS?
9