Decreasing Trauma Readmissions by Implementing a Call Back Program

Transcription

1 Decreasing Trauma Readmissions by Implementing a Call Back Program J Bath MSN, D Freeman MSN, M Salamoun BSMA, E Harvey DNP, A Wright MSN, M Hamill MD, D Lollar MD, K Love Bower MD, & B Collier DO

2 Conflict of Interest Disclosure Author Jennifer Bath Disclosures No known financial or related nonfinancial relationships to disclose that might reflect possible bias or affect the conclusions of this study. No external funding was solicited or needed for this study.

3 Background Decreased hospital length of stay (HLOS) Harrison et al. J Gen Int Med % of patients have an adverse event after discharge Lushaj et al. Ped Card 2016 Readmissions are a quality measure that affects reimbursement CMS.gov 2013

4 Background Prevention of Readmissions Call back systems Peds Cardiology Lushaj et al. Peds Cardiol Primary Care Tang et al. J Gen Int Med 2014 Urology Inman et al. Urol Nurs Geriatrics Legrain et al. J Am Geriatr Soc Trauma Gaines-Dillard J Trauma Nurs. 2015, Aaland et al. JTACS 2012

5 Background Call back programs varied Time of calls Caller Call scripts Post discharge bundles Soong et al. PLoS One. 2014, Aaland et al. JTACS 2012, Cochran et al. J Nsg Admin. 2012

6 Purpose & Setting To create and implement a call-back program To determine if a call-back program decreases trauma readmission rates Feasibility and time requirement Ascertain patient feedback

7 Methods 767 bed Level I Academic trauma center Verified (ACS & VA) Magnet/Beacon Full RN support for trauma

8 Methods Daily census & trauma log Charts reviewed for inclusion First call attempts were made hrs. after discharge EHR & Excel call log

9 Data Retrospective of registry (Oct 12-Sept 16) Demographics ISS TRISS HLOS Unplanned readmissions

10 Pre-intervention Groups Oct Sept Post-intervention Oct Sept Mature intervention Oct Sept. 2016

11 Characteristics Patient Pre Characteristics Post & Mature P Value Gender Age Male 62.4% Male 65.5% 0.002* % % % % % % Etiology DC Dispo ISS TRISS HLOS Blunt 88.6% Blunt 88% 0.36 Home 71.5% Home 67.5% * 11.7 ± ± 9.0 <0.001* 0.9 ± ± ± ±

12 Characteristics Patient Pre Characteristics Post & Mature P Value Gender Age Male 62.4% Male 65.5% 0.002* % % % % % % Etiology DC Dispo ISS TRISS HLOS Blunt 88.6% Blunt 88% 0.36 Home 71.5% Home 67.5% * 11.7 ± ± 9.0 <0.001* 0.9 ± ± ± ±

13 Readmission Rates No difference in rates between pre and post intervention groups. When the implementation year was excluded a significant difference in readmissions was found.

14 Readmission Rates FY13 vs. FY15 p=0.047*

15 Characteristic Readmitted Not readmitted P Value Post discharge readmissions Gender Male 68.7% Male 63.8% 0.36 Age % % % % % % Etiology Penetrating 18.5% Penetrating 11.3% 0.04* DC Dispo Home 62.6% Facility 37.4% Home 73.3% Facility * ISS 14.9 ± ± 9.3 <0.01* TRISS 0.9 ± ± HLOS 9.3 ± ± 8.4 <0.01*

16 Characteristic Readmitted Not readmitted P Value Post discharge readmissions Gender Male 68.7% Male 63.8% 0.36 Age % % % % % % Etiology Penetrating 18.5% Penetrating 11.3% 0.04* DC Dispo Home 62.6% Facility 37.4% Home 73.3% Facility * ISS 14.9 ± ± 9.3 <0.01* TRISS 0.9 ± ± HLOS 9.3 ± ± 8.4 <0.01*

17 Readmissions During Call Back Intervention

18 Cost 2500pts, 1170 attempts, 17% reached Call time mean 5.8 ± 2.9 minutes 0.2 FTE CNS = $6,612-$8,996 Average cost $11,141/readmission Total savings of $133,692 for 12 avoided readmissions

19 Comments Positive You told me stuff I wasn't aware of. You all were wonderful to me. You have a great crew up there. I would have taken him to the wrong kind of doctor. Negative Its unchristian the pain she was in. I sincerely hope that one of you goes through this experience someday so you can see how bad it is, it's like abuse I tell you. All I got was bunch of papers shoved at me and told "When are you leaving?"

20 Limitations Missing or invalid phone numbers Limited to discharges to home Difficult to assign quantitative analysis to the calls Correlating calls to patient satisfaction scores Inconsistent implementation

21 Lessons All patients could benefit Utilize registry data to identify who to call 0.5 FTE to call all patients could add financial benefits

22 Conclusions Call backs to all patient populations would be beneficial Answer questions Reinforce discharge teaching Real time patient feedback Service Recovery Improve patient satisfaction Reduce readmission rates

23 QUESTIONS? References Gaines-Dillard N. Nurse led telephone follow-up improves satisfaction in motorcycle trauma patients. J Trauma Nurs. 2015; 22(2): doi: /jtn Aaland MO, Marose K, Zhu TH. The lost to trauma patient follow-up: A system or patient problem. J Trauma Acute Care Surg. 2012; 73(6): doi: /ta.0b013e31826fc928. Cochran VY, Blair B, Wissinger L, Nuss TD. Lessons learned from implementation of post-discharge telephone calls at Baylor Health Care System, J Nsg Admin. 2012; 42(1): Doi: /NNA.0b013e31823c18c9. Legrain S, Tubach F, Bonnet-Zamponi D, Lemaire A, Aquino JP, Paillaud E, Taillandier-Heriche E, Thomas C, Verny M, Pasquet B, Moutet AL, Lieberherr D, Lacaille S.A new multimodal geriatric discharge-planning intervention to prevent emergency visits and rehospitalization of older adults: The optimization of medication in AGEd multicenter randomized controlled trial, J Am Geriatr Soc. 2011; 59: DOI: /j x Hansen LO, Young RS, Hinami K, Leung A, Williams MV. Interventions to reduce 30- day rehospitalization: A systematic review. Ann Intern Med. 2011; 155(8): doi: /