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Improving clinical communications at Dignity
Health’s St. Joseph’s Medical Center
October 2012
A value analysis of PerfectServe’s impact on hospital operations
2
Contents
Executive summary 3
The case for improving clinical communications 3
Key technologies enabling clinical communications improvement 6
DignityHealth’sSt.Joseph’sMedicalCenter 7
Studyapproachandmethodology 8
Benefitsanalysis 11
Closingremarks 21
AboutMaestroStrategies™ 22
AboutPerfectServe® 22
References 23
Publishedasasourceofinformationonly.Thematerialcontained hereinisnottobeconstruedaslegaladviceoropinion.
©2015PerfectServe,Inc.Allrightsreserved.PerfectServe®isaregisteredtrademarkandPerfectServeSynchrony™andProblemSolved™aretrademarksofPerfectServe,Inc.
perfectserve.com | 866.844.5484 | @PerfectServe
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Today’shealthcaredeliverylandscapeischangingrapidly.Withhealthcarereformlegislationandhealthcarepaymentreformattheforefront,moreemphasisisbeingplacedonefficientcoordinationofcareacrosssettingsandensuringaccesstocare.
Effectivecommunicationswithinandamongthecareteamareessentialtosafe,highqualitycare,efficientcarecoordinationandaccessmanagement.
PerfectServe,acompanythatprovidesanext-generation,clinicalcommunicationsplatformwhichmakesiteasyforclinicianstoconnectwitheachother,engagedMaestroStrategies,anationallyrecognizedhealthcarestrategyandtransformationfirm,tocompleteanindependent,third-partyevaluationofPerfectServe’simpactandvalueonhospitaloperations.
Thispaperexaminestheexperienceofonehospital,St.Joseph’sMedicalCenterofStockton,California,anditsinitialimplementationofthePerfectServeclinicalcommunicationsplatform.
MultiplebenefitsassociatedwiththePerfectServeimplementationwereidentified,includingenhancedpatientthroughput,improvedclinicaloutcomesandpatientsatisfactionrelatedtoquietnessscores.
Measuringthequantitativeandqualitativeimpactsbetweenadefinedpre-implementationperiod,andafive-monthpost-implementationperiodconfirmedsignificantchangesinoperatingperformance.
AsSt.Joseph’sMedicalCentercontinuestoexpandoncurrentadoptionanduseofthePerfectServeplatform,evengreaterbenefitsandvalueareanticipatedbytheleadershipteam.
Intoday’schallenginghealthcareenvironment,clinicianshavelimitedtimetospendwithpatients,makingcommunicationsbetweenclinicians,regardlessofthecaresetting,criticaltoensuringthebestoutcomeforthepatientandtheprovider.Unfortunately,thehealthcaredeliverysystemoftodaylacksstandardizedprocessesforcollaborationbetweencolleaguesbecausetherearelimitedtoolstoenableclinicianstoeffectivelyfilter,manageandprioritizecommunications.
Limitationsoncommunicationshaveasignificantimpactonbothpatientoutcomesandproviderproductivity.Accordingtooneestimate,
Executive summary
The case for improving clinical communications
4
U.S.hospitalswasteapproximately$12billionannuallyduetopoorcommunicationamongcareproviders;54%ofthewastecanbeattributedtoanincreasedlengthofstayandassociatedincreasedcostofcare.1
Inaddition,multiplestudiesindicatethat70-90%oferrorsareduetopoorcommunicationbetweenprofessionals.2Actualversuspredictedmortalityratesvarysignificantlybasedontheeffectivenessofcommunications(41%worsethanpredictedforpoorcommunicationsand58%betterthanpredictedforexcellentcommunications).3
Nurse-to-physiciancommunicationscanbeparticularlyproblematic.Astudyofnurse-to-physiciancommunicationfoundthatbetween10%and40%oftotalcommunicationtimewasspentattempting,butfailing,tocommunicatewiththecorrectprovider,whichmeantnurseswerespendingvaluabletimesearchingforinformationtodeterminetheappropriateproviderand/orphonenumber.4
Infact,14%ofallpagesweresenttothewrongphysician—aphysician/residentwhowasscheduledtobeoff-dutyoroutofthehospital—and47%ofthosewereurgentmessages.5“Theabilityofphysiciansandnursestoworkasaunifiedteamisessentialtoimprovedoutcomes,errorandriskreductionandoptimumcare.”6
Astudyonthebarriersofeffectivephysicianandnursecommunicationinthelong-termcaresettingshowedthatthethirdmostfrequentbarrierwasdifficultyreachingthephysician.7
Physician-to-physiciancommunicationsarealsoplaguedwithchallenges.Communicationhasbeenidentifiedasamajorcontributingfactorintheoccurrenceofsentinelevents.Handoffsandtransitionsarespecifictypesofcommunicationthatrequirethesuccessfultransferofinformationtoensuresafe,effectivepatientcare,andcurrently,thereisnostandardforcommunicatinginformationbetweenahospitalistandtheprimarycarephysician(PCP)atdischarge.8
Infact,effectivewaystomanagephysiciantransitionsandhandoffsarenotbeingtaughttotoday’sresidents.OfattendingphysiciansattheUniversityofColorado,Denverhospitals,only6%saidtheyhadbeenformallytaughthandoffsinmedicalschool,andonly28%hadbeenformallytaughthandoffsinresidency.9
5
Theuseofhospitalistsasinpatientcaregiverswithdischargetoprimarycarephysiciansforpost-dischargefollow-uphasdemonstratedthatphysician-to-physiciancommunicationshavebecomeincreasinglyimportant.Accordingtoonesource,directcommunicationbetweeninpatient(hospitalist)physiciansandPCPsoccurredduringonly3-20%ofhospitalizations.Atthetimeoffirstpost-dischargevisit,PCPsinthestudyhadreceivednowrittendischargeinformationinupto50%ofpatients.Only17%ofPCPsreportedreceivingnotificationfromhospitalistsaboutdischarges.10
Failuretofollowthroughwithhospitalistdischargeorders(durablemedicalequipment,follow-upvisitswiththePCPandothertherapiesorclinics)leadstoavoidableemergencydepartment(ED)visitsandre-hospitalizations.11Infact,between19%and23%ofpatientsrecentlyhospitalizedexperiencedanadverseeventafterdischargeduetosomeformofinadequatepost-dischargefollowup.12Theadverseeventsfrequentlyoccurwithinthefirstfivedaysafterdischarge.13AccordingtoCMS,infiscalyear2009,13%ofreadmissions(worthapproximately$12billion)werepotentiallypreventable.14
Communicationbreakdownsalsothreatenthesafetyofsurgeries.Areviewof444casesshowedthemostcommoncommunicationbreakdownsinvolvedfailureofaresidenttonotifytheappropriateattendingsurgeonofacriticaleventandnonexistentattending-to-attendinghandoffs.15
Finally,professionaloutcomemeasuressuchasjobstress,groupcohesionandnursesatisfactionwithdecision-makingarealsoinfluencedbynurse/physiciancollaboration.16
WiththeadventofhealthcarereformandaccompanyingnewmodelsofreimbursementincludingbundledpaymentsandValue-BasedPurchasing,transitionsofcaremustbemoreeffectivelycoordinated.Effectivecommunication between clinicians across the care continuum is essential forcoordinatingtransitions.
6
Thehealthcareindustrycontinuestoemploymultiplepointsolutionsandtechnologiessuchascallcentersandansweringservices,overheadpaging,securetextmessaging,web-scheduling/pagingsoftware,pagersandwirelessphones.
Thechallengewithmanyofthesetoolsisalimitedabilitytoaddressthecomplexityinherentinclinicalcommunicationprocesses—notonlywithinthehospitalbetweenoneormoresiloeddepartments,butacrossmultiplecaresettings,includingambulatory,acutecareandpost-acutecareenvironments.
Itisdifficultforclinicianstokeepupwithmanualphonelists,callschedulesandothersourcesofinformationthatarerequiredtoestablishactualcontactbetweenclinicians.
Communicationsdirectedtophysicianscanbeespeciallychallengingbecausephysiciansmustcontroltheiraccessibilityinordertomanagetheirtimeeffectively.Tothisend,physiciansoftenerectbarrierstoprotectthemselves(e.g.,third-partyintermediariessuchasansweringservicesandofficestaff),yet,inmanycases,thesebarrierscreatefriction,whichimpedescommunicationandcompromisescare.
Theemergenceandacceptanceofsmartphonesandtabletsinhealthcaresettingshasbeenessentialtodrivingnotonlyproviderproductivity,butimprovingthecoordinationofcareacrosssettings(physicianoffice,ambulatorysettings,acutecare,long-termcareandothers).Improvementinbothtechnologyandbandwidthcontinuestodrivemoresophisticatedmethodstoprovideeffectiveclinicalcollaborationandbetterpatientcare.
Anewtechnologyisemerging,whichisbuiltuponasecureandcomprehensivecommunicationsplatform,coupledwithadecisionrulesengineandpurposefulcommunicationsprocessdesign,optimizingcallandmessageroutingtoensureaccuracyandreliability;and,thus,enablesclinicianstomakedecisionsmorequickly.
Thisplatform,withbuilt-inalgorithmsthatdefineanorganization’sclinicalcommunicationsprocesses,facilitateseffectiveclinician-to-cliniciancontactbasedonanumberofvariables,suchastheoriginoftheinteraction,theoriginator’srole,thenatureandurgencyoftheinteraction,patientidentity,timeofday,dayoftheweek,callcoverageschedulesandtheclinician’spreferredcontactmethod.
Key technologies enabling clinical communications
improvement
7
St.Joseph’sMedicalCenterisanot-for-profit,359-bedhospitalinStockton,California,andisamemberofDignityHealth(formerlyCatholicHealthcareWest),whichincludesmorethan40hospitalsandcarecentersinCalifornia,NevadaandArizona.St.Joseph’sMedicalCenterhasover400physiciansonstaffandoffersspecializedservicesincardiovascularcare,comprehensivecancerservicesandwomenandchildren’sservicesincludingneonatalintensivecare.
Thechiefmedicalofficer,Dr.SusanMcDonald,identifiedtheneedtoimprovecliniciancommunicationsasacriticalissueatSt.Joseph’sMedicalCenteranddeterminedthat,whileprocessimprovementwasneeded,technologywouldbethekeytomanagingandmaintainingthecomplexcommunicationprocessalgorithmsuniquetophysicians.
Physicianfocusgroupsandinterviewswithnursemanagers,nursesandunitsecretariesthroughoutthehospitalrevealedthatwaste,frustrationandriskrepeatedlyarosefromSt.Joseph’sMedicalCenter’sexistingclinicalcommunicationsprocesses.Thesamegroupexpressedadesireforchangeandfeltstandardizingcommunicationsonasingle,intelligentplatformcouldhelpthemmeetthefollowingorganizationalgoals:
• Improvepatientsatisfactionbyreducingnoiseassociatedwithoverheadpagingofphysiciansinthehospital.
• Buildalignmentbetweenthehospitalandthemedicalstaff,andmakeiteasiertopracticeatSt.Joseph’sbyprovidingphysicianswithasingle,integratedsolutiontomanageallclinicalcommunications(whetherfromcolleagues,patientsorhospitalstaff).
• Improvepatientoutcomesbyreducingthenumberofrapidresponseteamcalls,codeblueeventsandmortalityratesthroughdecreasedtimetointerventionandtreatmentwhenapatient’sconditionisdeteriorating.
Dignity Health’s St. Joseph’s
Medical Center
“AsthenewchiefmedicalofficerforSt.Joseph’s,oneofthefirstissuesIwantedtoaddresswasimprovingcommunicationsbetweenphysiciansandbetweenphysiciansandhospital-basedstaff.Theneedwasapparent,andthesolutionneededtobetechnology-based.”
SusanMcDonald,M.D. Chief medical officer, St.Joseph’sMedicalCenter
8
• Improvepatientthroughputbyrefiningprocessesdependentonclinicalcommunications,resultinginreducedlengthofstaywithininpatientunitsandimprovedEDthroughput.
St.Joseph’sMedicalCenterelectedtodeployPerfectServebecauseofitsabilitytosimplifyandstreamlinecommunicationprocessessoclinicianscanbetterdirectandmanagepatientcare.
Unlikethepointsolutionsdiscussedintheprevioussection,PerfectServebroughtthreecapabilitiestoSt.Joseph’sthatareessentialtoeffectivelymanagethecomplexityinherentinclinicalcommunicationprocesses:
• Asecureandcomprehensivecommunicationsplatformwithanadvancedrulesenginepurpose-builtformedicine
• Aserviceorganizationtoquicklydriveprocessimprovementstandardizationacrosstheenterpriseandsustainitovertime
• Asuiteofintegrated,cloud‐basedapplicationsthatmakesiteasytoconnectinterdependentcliniciansinanycaresetting
PerfectServeengagedMaestroStrategies,anationally-recognizedhealthcaretransformationfirm,toprovideanindependent,third-partyevaluationoftheimpactofPerfectServeonhospitaloperationsatSt.Joseph’sMedicalCenter.
Withthecooperationofthehospitalleadershipteamandsupportpersonnel,MaestrowasabletoassessboththequalitativeandquantitativeimpactofPerfectServeandthenewcommunicationprocessesitenabledinanacutecaresetting.Thetimelinebelowrepresentskeymilestonesinthisassessment.
Study approach and methodology
9
Measurement period
Pre-implementation visit
Inordertounderstandthecurrentoperatingenvironmentaroundclinicalcommunications,MaestroStrategiescompletedatwo-daysitevisittoSt.Joseph’sMedicalCenterinOctober2011.Interviewswereconductedwithkeyleadership,nursingunitmanagersandphysicians.
Thepurposesoftheinterviewsweretwofold:1)togaininsightintothechallengeswiththecurrentmeansofcommunicationsbetweenclinicians,and2)todocumentexpectedbenefitsassociatedwithimplementingPerfectServe.Inadditiontointerviews,directobservationswereconductedonseveralnursingunitsandotherpatientcareareas.
Development of benefits hypotheses
Afterspendingtwodaysonsite,theMaestroteamcombinedandanalyzedtheinterviewresultsandobservationswithpotentialbenefitscitedfromliteraturereviewandresearchtodevelopanextensivelistofbenefithypotheseswhichcouldbetested.Thislistwasthenrefinedtotietoandreflectkeyobjectivesthatthehospitalleadershipteamwishedtoaccomplish.
Baseline measurement
Oncethepotentiallistofbenefitswasdeveloped,thedatarequiredtomeasurethosebenefitswasidentifiedandbaselinedatawasrequestedfromSt.Joseph’s.Inordertoaccountforseasonality,afullyearofdatafromtheperiodpriortothePerfectServeimplementationwasrequested.
Nov ’10 Jan ’11
Pre-implementa�onmeasurement period
Mar May Jul Sep Nov ’11 Jan ’12 Mar
Post-implementa�onmeasurement period
PerfectServe go-liveNovember 2, 2011
Site visit
10
Whereavailable,thedatawassubmittedonamonth-by-monthbasis.Thedatawasexaminedtodeterminecompletenessandsuitabilityforinclusioninthepost-implementationanalysis.Basedontheavailabilityofanddifficultyinacquiringthedata,somehypothesizedbenefitsweredroppedfromthelist.
Implementation of PerfectServe
ThePerfectServeteamspentseveralmonthspreparingforago-livedateofNovember2,2011.Pre-implementationactivitiesincludedthetechnicalaspectsofconfiguringthePerfectServehospitalapplicationsforbothWebandphoneaccess.SpecialemphasiswasplacedonexpandingtheuseofwirelessSpectralinkphonesbynursingstaff.
Afteranalyzingkeycharacteristicsofthemedicalstafftoidentifythosephysiciansmostlikelytodrivehighutilization,PerfectServeimplementationconsultantsbeganmeetingwithphysiciansandtheirstafftodocumenteachpractice’scurrentanddesiredstatecommunicationsprocessflows,callschedulestructureandeachphysician’sandmid-levelprovider’spersonalcontactpreferences.TheconsultantsthenassembledthisinformationwithinthePerfectServeplatformforeachpracticeworkgroupandmedicalstaffmember.
Priortogo-live,numerouseducationsessionswereheldregardingthefollowingtopics:
• Howtomodifyandmaintaincallschedulesandactivatedifferentpre-definedcontactprocesses
• Howtousethemobileapp,voiceandWebinterfaces
• Whattoexpectfromthenewcommunicationprocesses
• WhenandhowtousePerfectServe’shelpcenter
Duringthego-live,thePerfectServeteamwasonsiteroundinginthehospitalandmeetingwithphysicians,staffmembersinthehospitalandpracticeoffices,asrequiredtoaddressissuesassociatedwiththenewplatform.Overthefive-monthpost-go-liveperiod,PerfectServeconsultantscontinuedtoworkwithclinicianstooptimizetheircontactprocessesandhelpthemmaximizetheuseofPerfectServe’scapabilities.
11
Post-implementation measurement
Twoperiodsoftimewereselectedtomeasurepost-implementationimpactsofthePerfectServeprocess.An“earlyterm”measurementwasconducted,whichutilizeddatafromthefirst90-daypost-go-liveperiod.Amid-termmeasurementwasmadeforthesubsequent60days.Intotal,fivemonthsofpost-go-livedatawereexamined.Inadditiontothedataanalysis,follow-upinterviewswereconductedwithkeymembersoftheleadershipteamtobetterunderstandthebenefitsrealizedatSt.Joseph’sMedicalCenter.
InthefivemonthsfollowingthePerfectServeimplementation,St.Joseph’sMedicalCenterdemonstratedsignificantimprovementinclinicalprocessesdependentuponeffectiveandefficientcommunications.
WithPerfectServehandlingapproximately14,000clinicalcommunicationeventseachmonthduringthestudyperiod,thebenefitsachievedincludestandardizationofcontactprocessesandproceduresacrossthemedicalstaff.
Benefitsanalysisfocusedinthefollowingareas:
• Quietnessscores—patientsatisfaction
• Patient outcomes
• Patient throughput
Thenewcommunicationprocessesdramaticallyreducedthird-partyhandoffsandoverheadpaging,andeliminatedtheneedtomaintainandrefertomanuallistsandcallschedules.ThisinformationisallbuiltintoPerfectServealgorithms,allowingcallsandmessagestorouteaccordinglywithgreateraccuracyandreliability.
Quietness scores—patient satisfaction
PriortoPerfectServe,overheadpagingwastheprimarymeansofinitiatingasearchforaphysicianinthehospital.Overheadpagingwasidentifiedasadissatisfierforbothpatientsandphysicians.Onewaytomeasuretheeffectofreducedoverheadpagingistousepatient
Benefits analysis
12
satisfactionscoresrelatedtonoise.
TheHospitalConsumerAssessmentofHealthcareProvidersandSystems(HCAHPS)surveyiscompletedbypatientsortheirfamiliesatdischargeandconsistsofaseriesofquestionsaboutthepatientexperiencewhileinthehospital.
Thesurveyspecificallyasks:“Duringthishospitalstay,howoftenwastheareaaroundyourroomquietatnight?”Thepercentagescalculatedareforpatientswhoanswered“Always.”ForSt.Joseph’sMedicalCenter,thisparticularmetricwasconsistentlybeloworganizationaltargetsandwaspartofthereasonfordeployingPerfectServe.Scoresforquietnessimprovedby24%fromthepre-implementationperiodascomparedtothesameperiodpost-implementation.
“Overheadpaginghasalmostbeencompletelyeliminated,makingthehospitalaquieterplaceforourpatientsandstaff.Wearefindingthatthisisyieldinghigherpatientsatisfactionwithquietnessofthehospital.We’reexcitedaboutallthatwehaveachievedsofarwithPerfectServeforourphysiciansandnurses.”
DonWiley President & CEO, St.Joseph’sMedicalCenter
13
Percent of patients who responded to the statement: “Room was always quiet at night.”
ForSt.Joseph’s,thisrepresentsanestimated$95,000inrevenue.ThequietnessmeasureispartoftheaggregatedscoreusedtodeterminereimbursementunderValue-BasedPurchasingandcanpotentiallyaffectoverallMedicarereimbursement.UsingMedicareweightingschemes,theamountatriskforSt.Joseph’sMedicalCenterspecificallyrelatedtoquietnessscoresis$95,000peryearbasedon2011Medicarevolumesandcharges.
Patient outcomes
Communicationsrelatedtochangesinpatientconditionorpatientdeteriorationarecomplexandinvolveasignificantamountoftime.Directpatientcareprovidersmustleavethepatientbedsidetoinitiatecontactwiththephysiciantoobtainorderstointervenewhenapatient’sconditionchangesordeteriorates.Enhancedandtimelycommunicationbetween
0
15
30
45
60
0
15
30
45
60
Nov
Pre-implementation
Post-implementation
Dec Jan Feb Mar
HCAHPS scores for quietness have improved 24% post
implementation compared to the same period in the prior year.
For St. Joseph’s this represents an
estimated $95,000 in revenue.
14
thedirectcareproviderandthephysiciancanreducetimetotreatmentwhenpatientconditiondeteriorates.Moretimelymedicalinterventionmayalsoreducetheneedtoinitiatecallfortherapidresponseteam(RRT)andcanalsolessenthefrequencyofcodeblueevents.
Topositivelyimpactpatientoutcomesinadditiontostreamliningthenurse-to-physiciancontactprocess,PerfectServeworkedcloselywiththenursingstafftoincreasewirelessSpectralinkphoneadoptiontobetterfacilitatedirectphysician-to-nursecommunicationwhenarapidresponsewasrequired.OneachSpectralinkphone,PerfectServecanbeaccesseddirectlyviaadirectdialnumber.WhenanurseinitiatesacallintoPerfectServeusingaSpectalink,thenumberassociatedtothatnurse’sphoneisautomaticallyembeddedintothemessageforthephysician,which,inadditiontoprovidingautomaticdocumentation,makesthereturncalleasyforthephysician.
ThenumberofRRTcallsandcodeblueeventswasexaminedonaquarterlybasisandthenumberofcallsandcodesper1,000dischargeswascalculated.TherateofbothRRTcallsandcodeblueeventsdecreasedafterthePerfectServeimplementation.BecausedatawasonlyavailableonaquarterlybasisandthePerfectServeimplementationoccurredinthemiddleofaquarter,aspecificperiodoftimewasconsideredatransitionperiod.
PriortoPerfectServe,therateofRRTcallsoversixmonthsaveraged29callsper1,000discharges.Post-implementationtheratedroppedto28callsper1,000discharges,whichrepresentsa3%improvement.
Similarly,theaveragerateofcodeblueeventsper1,000discharges was14pre-implementationanddecreasedto11afterPerfectServe,a24%improvement.
Combined,thesestatisticsimplythatshortercommunicationcycletimesarelikelycontributorstomoretimelyinterventionsforpatientswhoseconditionsaredeteriorating.
15
RRT and code blue calls per 1,000 discharges
Arelatedstatisticistheimprovementinoutcomesforpatientswhohaveacodeblueevent.Thepercentofpatientsdischargedaliveafteracodeblueeventimprovedfromanaverageof24%pre-implementationto29%post-implementation.Furthermore,asconsumersscrutinizeindividualhospitalperformancethroughpubliclyavailabledatasuchasHospitalCompare,statistics,suchasmortalityrate,havethepotentialtodriveproviderchoiceandimpactmarketshare.Inaddition,payersusehospitaloutcomesandperformanceintheirnegotiationprocesswithproviders,whichdirectlyimpactshospitalrevenue.
The rate for both rapid response team (RRT) and code blue events decreased after the PerfectServe implementation.
Average RRT calls per 1,000
discharges dropped 3%.
Average code blue events per 1,000 discharges dropped 24%
Pre-implementation
RRT Code blue
Post-implementation
0123456789
101112131415161718192021222324252627282930
0
8
15
23
30
16
Percent of patients discharged alive
Patient throughput
Clinician-to-cliniciancommunicationisahighfrequency,highlyvariableactivityinhospitaloperations.Assuch,itsefficiencyandeffectivenesshaveasignificantimpactonpatientthroughputacrosstheacutecaresetting.
Nursesneedtoconnectwithphysicianstoobtainorderssotheycaninitiatecare.Whencommunicationcycletimesareunnecessarilylong,actionisdelayed,whichimpedesthroughput.Apatientwhoisreadytobedischarged,butiswaitingforfinalapprovalfromeithertheattendingoraconsultingphysician,maynotbeabletobedischargedinatimelymanner,resultinginanadditionalnightinthehospital—impactinglengthofstay.
Inaddition,patientsbeingadmitted(especiallythroughtheED)mayhavetowaitforanavailablebedonanursingunituntilexistingpatientsaredischarged.This,inturn,impactsEDthroughputaspatientswaitingtobe
0%
8%
15%
23%
30
0123456789
101112131415161718192021222324252627282930
Pre-implementation Post-implementation
The percent of patients discharged alive after a code blue event improved from
an average of 24% pre-implementation to 29% post-implementation.
17
seencannotbeplacedinanexaminationroomuntilpatientswaitingonadmissionhavebeenmovedtoinpatientunits.
Manytimes,extendedwaittimesintheEDresultinpatientsleavingwithoutreceivingcare.Inaddition,therearetimestheEDwillhavetodivertambulancestootherfacilitiesasithasnocapacitytoreceiveadditionalpatients.Thisresultsinlossofrevenuetothehospital,aswellaspotentiallycompromisingpatientsafety.
Reduced length of stay
Theaveragelengthofstay(ALOS)forthepost-implementationperiodwas4.68dayscomparedto4.75daysforthesameperiod(November-March).Thisrepresentsa1.6%decreaseinALOS.
Average length of stay (days)
ThishassignificantimpactoncontributionmarginforpatientswhosereimbursementisDRG-based(MedicareandMedi-Cal).
Average length of stay (ALOS) decreased 1.6% after the
PerfectServe implementation.
This has a significant impact on contribution margin for DRG-based
reimbursements, and represents a potential savings of $1,982,000 for St. Joseph’s.
4.50
4.58
4.65
4.73
4.8
Pre-implementation Post-implementation4.500
4.575
4.650
4.725
4.800
18
ForSt.Joseph’s,potentialsavingsrelatedtoreductioninALOSaresummarizedinthistable:
Length of stay improvement value analysis
AnnualizednumberofDRG-baseddischarges 11,605
Averagevariablecost/day $2,358
Averagelengthofstaypre-implementation 4.754days
Averagelengthofstaypost-implementation 4.682days
ReductioninLOS 0.072days
Estimated potential savings: (0.072 days) x ($2,358 cost/day) x (11,605 discharges) $1,981,552
Emergency department throughput
St.Joseph’sMedicalCenterhasanEDtriagesystemthatensureseverypatienthasabriefdiscussionwithaclinicianonceheorsheisregistered.However,dependingontheurgencyofapatient’sconditionattriage,theymaybeaskedtositinthewaitingroomuntiltheycanbeseen.Formanypatients,thewaittimescanbelongandtheyultimatelyleavewithoutreceivingcare.
The number of patients who left the ED without receiving care (for datacollectionandanalysispurposes,leavingagainstmedicaladvice(AMA)wasusedasaproxyforleavingwithoutreceivingcare)duringthepost-implementationperiodwas786comparedto986forthesameperiodpre-implementation.Thisrepresentsa20%decreaseinpatientswholeftAMA.
ThereductioninnumberofpatientsleavingAMAalsocorrelates(inversely)totheincreaseinnumberofpatientsseenasdetailedinthegraphbelow.
AsthenumberofpatientsleavingAMAdecreased,thenumberofpatientsseenandtreatedincreased.Theincreaseinthenumberofpatientsseenduringthepost-implementationperiodcomparedtothesamemonthsinthepre-implementationperiodwas11%.
19
Inaddition,theamountoftimespentondiversionhasdecreased.ThecombinationofthesethreestatisticsdemonstratethatSt.Joseph’sMedicalCenterhasbeenabletodramaticallyimpactEDthroughput—byseeingmorepatients,byreducingthenumberofpatientsleavingAMAandbylimitingtheamountoftimetheEDisondiversion.
Percent improvement in ED patient throughput
Theimplicationsforthisarebroad,aspatientcare,patientsafetyandpatientsatisfactioncanbepositivelyimpactedandtheorganizationcanrecognizerevenueopportunities.
After the PerfectServe implementation, the ED experienced 20% decrease in patients
who left against medical advice (AMA).
This correlates to an 11% increase in patients seen and treated.
In addition, the amount of time spent on diversion decreased by 50%.
Left AMA Patients seen Diversion0%
15%
30%
45%
60%
0
15
30
45
60
20
ED patient throughput improvement value analysis
Averagedirectmargin/EDoutpatient $355
NumberofpatientswholefttheEDAMAannuallypre-implementation 2,076
AnnualexpectedpatientsleavingAMAafterimplementation 1,655
ReductioninleftAMA 20%
Incrementalpatientsexpectedpost-implementation 421
Estimatedpotentialannualincrementalmargin(421patients)x($355directmargin/patient) $149,386
Benefits summary
St.Joseph’sMedicalCenterrealizedavarietyofbenefits,bothquantitativeandqualitative,throughtheprocessimprovementsPerfectServeenabled.
Thematrixbelowsummarizesthebeforeandafterimprovementandthefinancialimpactwhereapplicable:
Aspost-implementationinterviewswereconductedwithhospitalleadership,additionalbenefitsassociatedwiththePerfectServesolutionwereidentified.
Summary value analysis Before After % Improvement Impact
Reducednoise,increasedHCAHPS 38% 48% 24% $95,000
Reducedaveragelengthofstay 4.75 4.68 1.6% $1,981,000
DecreaseinEDpatientsleavingAMA 2,076 1,655 20%
$150,000
IncreaseinEDpatientsseen 19,762 21,875 11%
ReducedEDtimespentondiversion 11,282 5,594 50%
ReducedRRTcalls/1,000discharges 29 28 3% Quality
Reducedcodeblueevents/1,000discharges 14 11 24% Quality
Increased%dischargedaliveaftercode 24% 29% 21% Quality
21
Forexample,byprovidingnursestheabilitytoeasilyreachtheadministratoroncallviaPerfectServe,floornurseswereabletoresolveoperationalissuesmorequickly.Whilethereisnotametrictodescribethisbenefit,leadershipseesclearadvantagesinsimplifyinglinesofcommunication.
HealthsystemsthatusePerfectServetostandardizeexistingclinicalcommunicationprocesses—andenablenewprocesses—havethepotentialtosignificantlyimpactpatientcareacrossthecontinuum.
Asdocumentedinthispaper,thevalueofPerfectServe’sofferingshasclearlybeendemonstratedatDignityHealth’sSt.Joseph’sMedicalCenter.
Clinician-to-cliniciancommunicationisahighfrequency,highlyvariableactivity,which,whenunderthestatusquo,negativelyaffectshospitaloperationsandthequalityofcare.
Effectiveclinician-to-cliniciancommunicationcanbedramaticallyimprovedbydeployingasingleplatformsolutionthatenablesefficientprocessestomakeiteasytoconnectcliniciansacrossmultiplecaresettings.
Whenclinicalcommunicationprocessesareenabledwithrules-basedintelligenttechnology,communication,collaborationandcoordinationofcareoccurmorequickly.Thispositivelyimpactspatientoutcomes,patientthroughputandpatientandcareteamsatisfaction.
ThispaperrepresentstheearlymeasurementofresultsexperiencedbySt.Joseph’sMedicalCenter.ThereisanexpectationacrossseniorleadershipthatcontinuedeffortstoapplyPerfectServetogreaternumbersofcommunications—dependentclinicalprocesseswillleadtoanincreasedimpactwithexistingidentifiedbenefits,andthattherewillbe
“Whilewecannotattribute100%oftheimprovementinkeymetrics(suchaslengthofstay)specificallytoPerfectServe,webelievethatithascontributedtotheseimprovementsandthatoverall,PerfectServehaspaidforitself.”
DonWiley President & CEO,St.Joseph’sMedicalCenter
Closing remarks
22
additionalbenefitsthatwillbeidentifiedandquantified.
Whilethebenefitsmeasuredinthisstudywereconfinedtotheinpatientsetting,PerfectServe’splatformextendsbeyondthefourwallsofthehospitaltooutpatientandambulatorycaresettingsformanyofSt.Joseph’sphysicians.
ThereisfurtheropportunitytoexpandPerfectServecapabilitiestohelpenableclinicalintegration,carecoordinationandimprovementsincostandquality.
MaestroStrategiesisanationallyrecognizedhealthcarestrategyfirmspecializingintechnologydriventransformation.MembersoftheMaestroteamhaveservedasthoughtleadersintheareaofreturnoninvestment(ROI)andbenefitsrealizationforovertenyears.Authorsoftheaward-winningbookseriesonreturnoninvestmentofHIT,Maestroworkswithhealthcareleaderstoplanforvalueandthenmanagethatvalueintoreality.Formoreinformation,pleasevisit:www.maestrostrategies.com.
Servinghealthsystemstoimproveoutcomesandefficiency,PerfectServe’ssecureandcomprehensiveclinicalcommunicationsplatformmakesiteasytoconnectcliniciansacrossthecontinuumsotheycanbettercoordinatecare.BasedinKnoxville,Tennessee,PerfectServeprocessesmorethan35milliontransactionsannually,connectingmorethan50,000physiciansinmorethan118hospitalsand14,000medicalpracticesacrosstheUnitedStates.Formoreinformation,gotowww.perfectserve.comorcall866.844.5484.
About Maestro Strategies
About PerfectServe
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