Here - American Geriatrics Society

P OSTER
A BSTRACTS
Results:
The HOPE program has 175 enrolled patients, showing 25% reduction
in acute care hospitalizations, only 5% readmission rate, and
a cost saving of $1.3million/year. The INTERACT II program has
generated a saving of at least $500,000/year in avoided inpatient admissions.
The Enhanced Palliative Care program is estimated to reflect
a cost avoidance of $600,000 over the first two years by minimizing
aggressive management.
Discussion:
In today’s climate of healthcare reform, our approach seeks to
improve patient care quality with cost effective implications. We present
a three pronged intervention of managing the most vulnerable
geriatric population through patient centric home monitoring, integrated
care of NH residents, and appropriate evaluation for terminal
care needs. We hope to expand our pilot programs to suit the need of
a managed or accountable care organization.
C121
Transitions Bundle: Ensuring smoother transitions at hospital
discharge.
A. Hayward, 1 R. Rastogi, 2 T. J. Hillstrom, 2 C. A. Barnes. 1 1. Care
Management Institute, Kaiser Permanente, Portland, OR; 2. Sunnyside
Medical Center, Kaiser Permanente, Clackamas, OR.
Supported By: Project undertaken as quality improvement activity
by Kaiser Permanente
Background: Across the US one in five Medicare patients is
readmitted to the hospital within 30 days after discharge. Some readmissions
are preventable. After discharge, patients don’t always know
whom to call with questions, what medicines to take, or how to obtain
follow-up care. Those physicians and clinicians responsible for providing
post-hospital care don’t always receive timely, accurate, and
complete information about these patients.
Methods: Kaiser Permanente’s Sunnyside Medical Center created
a process to improve the transition for all patients discharged to
post-hospital care. First, a diagnostic evaluation identified that 10 to
40% of readmissions were preventable. Next, a design team including
staff and patient input developed, tested and implemented a “transition
bundle”, the aim of which was to improve care for every patient
after hospital discharge. Thirty-day readmission rates were measured
before and after implementation. Components of the “bundle” included
the following:
1. risk assessment and care tailored to likelihood of re-hospitalization
2. standardized discharge summary completed on the day of discharge
and available in the electronic medical record
3. pharmacist’s review of medications, followed by a phone call
to those patients at high risk, as well as review for all patients discharged
to a skilled nursing facility
4. first follow-up appointment scheduled before discharge for all
patients: within five days for those identified at high risk, within 10
days for those at medium risk, and within 30 days for all others
5. follow-up RN phone call within 72 hours of discharge for all
high risk patients
6. discharge instruction sheet with dedicated phone number for
all questions
Results: Overall year-to-date readmission rates at Sunnyside
Medical Center decreased from 12 to 9.8% in 2011 and rates for
Medicare members from 14 to 13%. More than half of patients discharged
were seen for a follow-up visit within five days. Ninety-two
per cent of discharged patients reported that they received written
information.
Conclusions: A transitions bundle composed of six elements improved
continuity of care for patients discharged from the hospital
and has been associated with a decrease in readmission rate.
C122
Changing the norms for trainees to prevent inappropriate
emergency room referrals.
N. K. Patel, 1,2 C. M. Espinal, 1,2 U. T. Efoevobokhan, 1,2 R. W. Parker. 1,2
1. Geriatrics, University of Texas Health Science Centera at SA, San
Antonio, TX; 2. Geriatrics, Christus Santa Rosa, San Antonio, TX.
Background: Transfers between settings of care are referred to
as transitions. Emergency Room (ER) transfers of patients from
nursing homes(NH) for inappropriate reasons is expensive, worsens
patient outcomes, hastens functional decline and decreases the quality
of life. The average wait time in an ER in San Antonio is 4-6 hours.
The average local ER visit for a geriatric patient costs anywhere from
$4,000-$6,000. This project done at the University of Texas Community
Geriatrics directed nursing homes where residents in family
medicine are the first called for the group. On reviewing call center
calls it was noted that many residents from NH were being sent to the
emergency room for inappropriate reasons, majority of the referrals
were afterhours and by trainee residents who were unfamiliar with
the patients, lacked the confidence, knowledge and skill of managing
frail elders.
Objectives:To sustain the norm of preventing inappropriate ER
transfers of patients by trainees from UT Medicine nursing homes by
100% in response to after hour calls. This project also sought to open
a dialogue between the NH, clinical staff, the residents, and the after
hour call center to facilitate better care for the residents in the nursing
homes.
Design: Quality improvement project.
Metric: ER visits of NH patients obtained from call center logs,
calls tracker and chart reviews.
Study Period: July 2010 to June 2011.
Intervention: The norm was changed. All residents in training
could not send a patient to ER without discussing the patient with the
attending on call. The on call team maintains a call tracker and the
call center maintains a log.
Results: Tracking the calls and following the intervention decreased
the number of inappropriate ER visits to zero.The norm is sustained
even beyond a year because of reinforcement and monitoring.
Conclusions: Changing the norm of residents in training helped
reduce the inappropriate ER visits. This also influenced the faculty
behavior. Total number of calls reduced with the use of the SBAR
tool and fact that calls were being tracked.
Next Step: The call logs will continue to be collected from the
clinical staff on call after hours. Complement with the Interact II
program, track day time calls and education of families regarding
ER transfers vs. treatment either in NH or direct admission to the
ACE unit.
C123
Facilitating Geriatric-focused Primary Care Electronically: A
Follow-up.
C. Gardner. Elder Care, Kaiser Permanente, Atlanta, GA.
Kaiser Permanente Georgia recognizes the importance of identifying
and meeting older patients’ needs. In 2010 we developed and
implemented interventions for non-geriatricians to easily address
topics not routinely discussed with younger patients, leveraging our
electronic medical record. A template is used at new patient and annual
40-minute visits for patients 65 and older. This decision support
tool prompts primary care physicians to assess, discuss, and appropriately
document actions re: topics including functional status, incontinence,
falls, cognition, and advance directives. It provides options for
interventions and prompts ordering recommended screenings and referring
to Geriatrics. Patient instructions important in older people
(e.g., regarding screenings, fall prevention, incontinence) automatically
print. The elder-focused review of systems and patient instructions
are also available to all clinicians for use in patients not scheduled
for a comprehensive primary care visit.
AGS 2012 ANNUAL MEETING
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