Tragedy to Transformation Patient and Family Advocacy and Carolinas HealthCare System HEN. Julia Lanham Michael Ruhlen

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1 Tragedy to Transformation Patient and Family Advocacy and Carolinas HealthCare System HEN Julia Lanham Michael Ruhlen

2 Linking Patient and Family Engagement (PFE) to Outcomes Completed Deep Dive with each hospital on PFE criteria Evaluated hospitals based on PFE criteria Identify PFE high performers 3+ score on PFE criteria 7 PFE high performing hospitals; 22 hospitals other cohort Reestablished HEN baselines for each measure Aggregate of hospitals in each cohort High performers cohort and other cohort baselines Aggregated HEN performance results for both cohorts Evaluated two questions for each measure: Which cohort performed at a lower rate? Which cohort achieved a greater reduction? 2

3 2013: Our Pivotal Year for PFE Late 2012 creation of Chief Patient Experience Officer Patient and Family Advisory Councils established in many hospitals System Patient Experience Steering Committee - June 2013 Leadership Development Institute (LDI) for System focus on patient experience August 2013 System agreement to incorporate patient experience scores as corporate goal in 2014 August 2013 HEN PFE rounding pilot launched

4 Sample of Results Measure Number of falls with injury per 1,000 patient days (NDNQI) CHS P&FE High Performers Baseline (2010) 0.08 (19/226,467) CHS P&FE High Performers Results (Jan 2012-Mar 2014) 0.05 (25/505,993) CHS P&FE High Performers Reduction Percentage Other CHS Hospitals Baseline (2010) % 0.11 (51/462,415) Other CHS Hospitals Results (Jan Mar 2014) 0.11 (166/1,520,790) Other CHS Hospitals Reduction Percentage + 1.0% PSI 12: Postoperative Pulmonary Embolism or DVT 4.09 (58/14,191) 2.99 (103/34,498) % 4.44 (147/33,115) 4.22 (291/68,947) - 4.9% Early Elective Delivery (PC-01) 3.54% (42/1,188) 1.03% (23/2,235) % 11.32% (474/4,188) 3.11% (199/6,393) % PSI 17: Birth Trauma Injury to Neonate 1.68 (10/5,953) 1.00 (15/15,049) % 2.11 (37/17,530) 1.67 (61/36,573) % Rate of 30-day allcause readmissions (AMI, HF, PN) (575/3,747) (1,285/10,236) -18.2% (2,247/12,148) (4,784/29,551) -12.5%

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8 Tragedy to Transformation Julia Lanham Patient and Family Advocate

9 Andrea s Story (Julia Lanham) The future is not a result of choices among alternative paths offered by the present, but a place that is created--created first in the mind and will, created next in activity. The future is not some place we are going to, but one we are creating. The paths are not to be found, but made, and the activity of making them, changes both the maker and the destination. John Schaar 9

10 Tragedy to Transformation Michael Ruhlen, MD, MHCM, FAAP Chief Medical Officer Carolinas HealthCare System Pineville

11 Carolinas Medical Center - Pineville

12 Carolinas Medical Center - Pineville Carolinas Medical Center - Pineville is an acute-care facility offering tertiary medical services. It is located on the southern Charlotte Beltway and is approximately 2 miles from the South Carolina / North Carolina Border 206 Acute Care Beds 30 Critical Care Beds 30 Inpatient Rehabilitation Beds 14,000 Inpatient Admissions / Year 40% South Carolina Patients LDRP, Virtual Critical Care, EMR Predictive Analytics, Facility-Wide Lean CMS, Joint Commission Recognitions 12

13 Carolinas Medical Center - Pineville Commitment to own and understand Andrea s loss and to change in response Meetings with family Initiated medical staff peer review process and PDSA teams Reviewed pain management practices facility-wide including Press-Ganey survey pain results Identified gaps in medication dosing practices Initiated pain management steering committee and through this mechanism, have impacted both inpatient and ED pain care Implemented a hospital-wide pain team Identified care team gaps in knowledge of Sickle Cell Disease and management 13

14 Carolinas Medical Center - Pineville Commitment to learn Created and deployed a series of educational interventions on sickle-cell management including mandatory sessions for physicians Care team meetings with Studer Coach Pain team educational sessions on Complementary and Alternative medicine techniques 14

15 Carolinas Medical Center - Pineville Commitment to engage Opportunity to meet with CHS Patient Experience leaders Presentation at System-Wide Leadership Development Institute Presentations at system and national HEN meetings 15

16 Carolinas Medical Center - Pineville Commitment to sustain and to spread System-wide Sickle-Cell Awareness activities Recruitment of nationally-prominent expert in Sickle-Cell Disease and her entire clinical team Training of all metro hospitalist teams so that each will be able to offer state of the art Sickle-Cell management services in collaboration with the Sickle-Cell Center Sickle-Cell Collaborative established System-wide Sickle Cell Steering Committee Foundation Fund created to receive contributions First-time disclosures of such nature outside the system 16

17 Carolinas HealthCare System Sickle-Cell Program 17

18 Carolinas HealthCare System Sickle-Cell Program Vision: The Sickle Cell Program at Carolinas HealthCare System & Levine Cancer Institute (CHS/LCI-Sickle Cell Program) provides consultative specialty comprehensive care to adults with sickle cell disease in a patient-centered and culturally sensitive approach to improve the life of those living with sickle cell disease. We strive to be nationally recognized as a leader in the transformation of healthcare delivery for individuals with SCD and to be chosen for the quality and value of services we provide. 18

19 Started Clinic 4/24/14 YTD SCD Program Total Enrolled in SCD Program 189 YTD Staff: Program Manager 1.0; RN 1.0; CSW 1.0; Intern 1.0 (pending hire ACP 1.0; RN 1.0, Psychologist 1.0) SCD Clinic: 2 full days /week (case management appts prn daily) Instituted ED Care Plans (individualized ED and Inpt Pain management plan) for pts seen in program Developing Cerner SCD VOC Power Plan or order set for ED for those without an individualized plan Nursing Supportive Care Guidelines/Protocol in development for SCD Inpatient Working on details with nursing, dedicated SNL for CHG approved Inpatient support for CHG/Staff Med (work in progress) Established General idea of Tier based system for SCD consults (1-3) Fleshing out the details with NMH/CHG and Staff Med 19

20 Patient Name HC Utilization Pre and Post SCD Program 1st clinic date Avg ED visits pre clinic/mo. Avg ED visits post clinic/mo. % Change in ED visits Total clinic visits Avg clinic visits/mo. CB 5/9/ % 21 3 JD 5/13/ % ND 8/18/ % JE 6/19/ % LG 6/26/ % AH 5/8/ *5.6% LM 4/24/ % TO 7/15/ % 5 1 JS 5/8/ % JT 5/22/ % GW 8/29/ % 6 2 Sample of top 10 Health care Utilizers with SCD. The average monthly ED visits, average monthly ED/IP visits, percent of change, total clinic visits, and average monthly clinic visits pre and post SCD program enrollment