Getting HELP (Hospital Elder Life Program) for at Risk Older Patients

Transcription

1 Getting HELP (Hospital Elder Life Program) for at Risk Older Patients Mark A. Supiano, M.D. Professor and Chief, Geriatrics Division Director, VA Salt Lake City Geriatric Research, Education and Clinical Center Executive Director, University of Utah Center on Aging

2 Presentation Outline Timeline our implementation story Getting started business tools Outcome Data Next Steps Questions 2

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4 Timeline 1 Date Meet with UHC Chief Medical Officer Submit UUMG Quality Initiative Proposal Sharon Inouye presents Dept. of Medicine Grand Rounds HELP approved, The project promises to improve our patient experience, and reduce morbidity and cost ; I very much like the Elderlife Team plan and support it Support provided only for Elder Life Specialist (ELS) Hire ELS; collect pre-intervention data Recruit, train volunteers Launch program on AIM-B unit 4

5 Timeline 2 Date month benchmarks reviewed FY12 HELP Budget approved in Dept. of Medicine s support Replace ELS Today Next steps 24 volunteers, all medicine units, CVMU, Rehab, Ortho, Trauma, Neurology and Neurosurgery 5

6 Getting started Conceptual support CMO, CNO, quality officer Volunteer services Began as a quality initiative > $1M Sitter 1:1 cost as driver Fall prevention Getting buy-in Evidence basis Grand Rounds, Chair s support 6

7 Making the Business Case 7

8 Patient Volume 8

9 HELP Team Size 9

10 Volunteer Program Size 10

11 Program Budget 11

12 Pre-intervention Data Medicine unit; pts. > age 70; > 2-day LOS Delirium incidence 33% $8K additional costs/ case of delirium 12

13 Benchmarks 1 Benchmarks to sustain HELP support into FY12 If the following benchmarks are met and 75% of the program s expenses are covered through a combination of these sources in FY11, UHC Hospital support for the program will continue in FY12. 13

14 Benchmarks 2 Projected cost savings to offset the program s expense derive from a combination of the following sources: an anticipated 30% decrease in delirium incidence reduction in need for close observation staffing - "sitter" expenses contribution of volunteer labor direct clinical care provided by Elder Life team. 14

15 Six-month Outcome Data 1 Enrolled 84 medical patients Delirium incidence: 9/84 = 10.7% Expected 28 cases of delirium 28 9 = 19 x $8K = $306,090 annual cost savings Close observation hours not available 15

16 Six-month Outcome Data 2 Volunteer labor N=24; 1,100 hours - $22,000 Additional benefits HELP team s clinical recommendations Fall reduction. Zero falls among 84 pts. enrolled (base rate is 3.4/1,000 pt days) Exceptional patient experience Letters of support, nursing satisfaction, SLC Trib article, UHC Insider article 16

17 (Paul Fraughton The Salt Lake Tribune) Bill Kleinschmidt, left, talks with a patient in the University of Utah Medical Center. Bill is a volunteer in the hospital's elder life program (HELP) aiding the patient with their ensory needs, helping them stay oriented to their surroundings. Volunteers help elderly patients at University Hospital stay grounded Article Tools» Comments ( 6 ) BY PATTY HENETZ The Salt Lake Tribune First published Jan :28PM Updated Jan 24, :58PM 17

18 Current Status Expanded to Ortho, Trauma, Rehab, Neurology and Neurosurgery 325 pts. enrolled to date with 5% delirium incidence 18

19 Next steps Recruit and train additional volunteers Expand to Huntsman Cancer Institute Use as springboard for NICHE and other inpatient programs (e.g., Geriatric Fragility Fracture) 19

20 Lessons learned and challenges It always takes longer than I think. Calculate SSRI, PPI and Rogain costs during start-up, and thereafter. Know who is in charge who controls hospital $ - and what their drivers are (e.g. 1:1 sitter costs) Silos program support for hospital-wide program is funneled through Dept. of Medicine 20

21 Conclusion Getting HELP implemented in our hospital has been very successful. In last 18 months, 90 fewer patients have developed delirium. 21

22 HELP Team Mark Supiano, MD Director Katherine Anderson, MD Geriatrician Miriam Beattie, DNP, GNP Elder Life Nurse Specialist Christy Martinson, MS Elder Life Specialist. 22

23 Questions... About our logo... The bristlecone pine tree (Pinus longaeva) - the earth s oldest inhabitant with a life span of 4,000 years - is found only in Utah and five other western states. Its extraordinary longevity and ability to adapt and survive in extremely harsh environmental conditions above 10,000 feet embodies the investigative spirit and mission of the Utah Center on Aging. 23