Focused on readmissions after participation in a GLPP HIIN Improvement Action Network
In August 2017, the Karmanos Cancer Center, Detroit, the largest cancer research and provider network in Michigan, began its focus on readmissions through its voluntary participation in an Improvement Action Network (IAN).
IANs are hosted by the MHA Keystone Center and provide a small group of hospitals with the opportunity to receive specialized coaching on mitigating an area of harm. The IANs require a strong commitment from the hospitals — typically three to four months — to dedicate staff time and resources to understand areas of opportunity through use of quality improvement skills.
“When we participated in the Readmissions IAN, we realized we had a great opportunity to take an in-depth look at our inpatient data and readmission rates,” said Patrice Tims, RN, BSN, MSA, director of Quality, Regulatory Affairs and Clinical Excellence at Karmanos Cancer Center. “By participating in this unique MHA Keystone Center initiative, it required us to look at what we were doing, make a plan and create changes for improvement.”
One of the first tasks was to collect and understand the data.
“This was challenging at the beginning, as we wanted to solve the problem before we understood the contributing factors or determined the root causes of patient readmissions,” Tims said. “We learned the number one reason for readmissions was pain, closely followed by nausea, vomiting and acute kidney injuries.”
Karmanos opted to drill down on readmissions to determine patients’ point of entry when being readmitted to the facility.
“We discovered that 85 percent of patients that were being readmitted came from another facility’s emergency department (ED), since Karmanos currently does not have its own dedicated emergency department,” said Vera Szram-Senyk, quality improvement specialist. “We also learned that 70 percent of our patients were at risk for being readmitted to the hospital after being discharged.”
One of the biggest preliminary initiatives was to drive patient traffic to the Karmanos Acute Care Clinic (ACC), a facility that supports the continuum of care for Karmanos patients, in lieu of an emergency room at another hospital.
“Karmanos started the ACC so patients would have a place to go to treat or manage acute symptoms or side effects,” said Szram-Senyk. “The ACC gives our cancer patients a very unique environment to manage symptoms. For example, they can come in and receive IVs if they’re dehydrated or have their medications revised, if needed.”
Karmanos’ ACC is open Monday through Friday from 7 a.m. to 7 p.m. Appointments are scheduled in advance and can occur the same day or even within an hour, depending on the specific patient’s needs.
Karmanos also sought to drive improvement in readmissions by focusing on the following efforts:
- Identify high-risk patients by implementing a readmission risk assessment tool and developing discharge protocols for those patients.
- Schedule a follow-up appointment in the clinic prior to the patient leaving the hospital. Patients at high risk for readmission have this appointment scheduled within three days after discharge.
- Have medications filled and given to patients prior to being discharged.
- Include physician and ACC contact information with discharge information.
- Direct patients to call their physician to review symptoms prior to going to an ED. Physicians can also schedule an ACC visit after reviewing patient symptoms.
- Improve utilization of ACC for management of chemotherapy and cancer pain.
- Increase patient referrals to supportive services to improve pain management and psychosocial support.
- Increase patient compliance with discharge instructions by placing follow-up phone calls within 72 hours of discharge to ensure patients understand their instructions, have pain medications and keep their follow-up appointment.
- Review data collected from follow- up discharge phone calls to identify opportunities to provide needed information and appropriate follow-up care.
Success of the Karmanos readmissions task force is due to the involvement of multiple disciplines, including quality, case management, nurses and physicians, who have the same goal – to provide high-quality, safe care that is effective and patient-centered. The team’s overall goal is not only to reduce readmission rates, but provide a greater patient experience through improved service and better communication among physicians, staff and patients.
Photo Caption: (From left to right) Karmanos’ Readmissions Taskforce team includes Patrice Tims, RN, BSN, MSA, director of Quality, Regulatory Affairs and Clinical Excellence; Kirsten Dahlgren, director, Utilization Management and Admitting; Anne Payne, director, Karmanos Clinics; Truvella Murray, manager, Case Management and Social Work; Kathy Fedoronko, director, Patient Care Services; Michael Stellini, MD, leader of the Supportive Service Multidisciplinary Team; and Nina Hudgins, manager, Patient Care Services. Not pictured are Steve Rea and Vera Szram-Senyk, quality improvement specialists, and Philip A. Philip, MD, PhD, FRCP, leader of the Gastrointestinal and Neuroendocrine Tumors Multidisciplinary Team at Karmanos.