IHI Expedition: Palliative Care in the Emergency Department Session 4 Tammie Quest, MD David Weissman, MD, FACP Kelly McCutcheon Adams, MSW, LICSW These presenters have nothing to disclose
Today s Host Kayla DeVincentis, Project Coordinator, has worked at IHI since 2009, starting as an intern in the Event Planning department. Since then, Kayla has contributed to the STAAR Initiative, the IHI Summer Immersion Program, and the IHI Expeditions. Kayla obtained her Bachelor s in Health Science from Northeastern University and brings her interest in health and wellness to IHI s Health and Fitness team. 2
WebEx Quick Reference Welcome to today s session! Please use Chat to All Participants for questions For technology issues only, please Chat to Host WebEx Technical Support: 866-569-3239 Dial-in Info: Communicate / Join Teleconference (in menu) Raise your hand Select Chat recipient Enter Text 3
When Chatting Please send your message to All Participants NOT All Attendees 4
Our Expedition Director Kelly McCutcheon Adams has been a Director at the Institute for Healthcare Improvement since 2004. Her primary areas of work with IHI have been in Critical Care and End of Life Care. She is an experienced medical social worker with experience in emergency department, ICU, nursing home, sub-acute rehabilitation, and hospice settings. Ms. McCutcheon Adams served on the faculty of the U.S. Department of Health and Human Services Organ Donation and Transplantation Collaboratives and serves on the faculty of the Gift of Life Institute in Philadelphia. She has a B.A. in Political Science from Wellesley College and an MSW from Boston College. 5
Overall Program Aim The aim of this Expedition, Emergency Medicine and Palliative Care, is to help empower professionals to care for patients and families with palliative care needs in the emergency department setting. 6
The Expedition Session #4: May 31 st, 2012 1:30pm EST System Design and Improvement Tools Session #5: June 14 th, 2012 1:30pm EST Achieving Change That Will Endure
Today s Faculty Tammie E. Quest, MD Associate Professor, Emory University School of Medicine, Department of Emergency Medicine and Division of Geriatric Medicine, Atlanta VAMC Director, Emory Palliative Care Center Director, Improving Palliative Care Emergency Medicine (IPAL-EM) Director, Education in Palliative and End of Life Care Emergency Medicine
Today s Faculty David Weissman, MD, FACP, is a Professor Emeritus, and Founder of the Medical College of Wisconsin Palliative Care Center. He is Board Certified in Medical Oncology, Hospice and Palliative Medicine. In 1991 he began one of the first academic palliative care programs in the United States. In 2003, the Medical College of Wisconsin s Palliative Care Program was designated as one of six United States Palliative Care Leadership Center s by the Center to Advance Palliative Care. Dr. Weissman is director of EPERC, End-of-Life Palliative Education Resource Center and he was the Founding Editor of the Journal of Palliative Medicine. Currently, he directs the Medical School Palliative Care Education Project and serves as a consultant to the Center to Advance Palliative Care and runs a consulting practice, Palliative Care Education, LLC. 9
Today s Focus Review Homework Explore New Content System Design and Improvement Tools Move forward on our trek
Homework from Session 3 Review charting/emr systems Identify other potential sources of data (eg, hospital databases) Select a preliminary panel of key metrics with specified data sources Begin data collection
Discussion of Session 3 Homework What were you able to do? What did you learn? What successes did you have? What barriers did you encounter?
Objectives of Session 4 System Design and Improvement Tools Identify key areas for pursuing priorities from baseline data Identify the 3 key questions for thinking about systems design Describe examples of efficient systems, templates and tools
Identify key areas for pursuing priorities from baseline data
Use your needs assessment Where is the low hanging fruit? Is the agenda mutual? System constraints System needs Is there energy to make it happen even if there is system strain?
Before Measurement: Know Your ED Characteristics ED size Visits/year, beds, observation unit Admission rate Number, acuity Core ED Metrics Average/median LOS Special populations Sickle Cell Disease, Pulmonary Fibrosis, Advanced Heart Failure/LVAD)
Case Example You have a 42,000 visit/year emergency department with 20 beds and it is the regional referral center. Your ED-PC Committee team would like to try and begin identifying patients that might be eligible for hospice care with transfer from the ED straight to hospice care. What information might you find helpful to know when you present this to your ED leadership team?
Case Example (cont d) Your team plans to call the local hospice when someone meets criteria and have them evaluated. The goal is to avoid admissions of patients that might be able to go home, get better pain/symptom control and improve pt/family satisfaction.
ED ALOS Admitted Patients
ED ALOS All Patients
ALOS Discharged Patients
Systems Thinking What do we know about (one aspect) of our system? What other drivers might be present? What might still be done to work within the system?
What to propose? After meeting, the ED-PC Champion group decides to focus on screening already admitted patients, waiting for a bed, for hospice criteria. In those patients, they decide that they will call the social worker to meet with the family in the ED or on hospital day #1 to discuss hospice eligibility.
Early Hospice Referrals for the ED 12 10 8 Hospice Referrals from ED to SW Intervention In-service to RN s regarding hospice criteria in ALREADY ADMITTED PATIENTS AWAITING BED RN checks with ED MD to see if referral to SW appropriate RN calls SW No change 6 Hospice Referrals from ED to SW 4 2 0 Sept Oct Nov Dec Jan Feb March April May Start of Intervention
Identify the 3 key questions for thinking about systems design
Key Questions What changes are needed in clinical practice (including staffing)? How will these changes be captured and reflected in documentation? How will data be collected on measures of improvement?
Describe examples of efficient systems, templates and tools
Emory University Hospital Midtown Family Presence During Resuscitation Death Packet Insert http://www.capc.org/ipal/ipal-em/improvement-and-clinicaltools
http://www.capc.org/ipal/ipal-em/improvement-and-clinicaltools
http://www.capc.org/ipal/ipal-em/improvement-and-clinicaltools
http://www.capc.org/ipal/ipal-em/improvement-and-clinicaltools
http://www.capc.org/ipal/ipal-em/improvement-and-clinicaltools
http://www.capc.org/ipal/ipal-em/improvement-and-clinicaltools
http://www.capc.org/ipal/ipal-em/improvement-and-clinicaltools
Key Questions/Summary What changes are needed in clinical practice (including staffing)? How will these changes be captured and reflected in documentation? How will data be collected on measures of improvement? Pick something where you can get an EASY win and move to larger challenges
Homework Assignment Identify one priority area for improvement with clinical documentation and monitoring components to facilitate improvement
Final Session Thursday, June 14, 1:30 PM 2:30 PM ET Session 5 Achieving Change That Will Endure 37