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Straight Talk
A weekly update from management on the issues that matter most.

Sep 27, 2018
The powerful positive force of cultural transformation when applied to patients’ best interests has profoundly wonderful consequences. NCH is currently jumping to the next higher level of patient experience while simultaneously lowering hospital acquired conditions and length of stay.

We have maintained our 5 star rating—the top ranking from the Centers for Medicare and Medicaid (CMS).  Of the seven categories, safety of care, readmissions, and efficient use of imaging are standard deviations better than the other 4,000+ rated hospitals.  Mortality, timeliness of care, and effectiveness of care are similar to other systems.  However, we are addressing the weakest of our CMS ratings, namely patient experience.  www.medicare.gov/hospitalcompare/search.html

 

About ten weeks ago, 4 North on the Baker Campus was selected for a pilot study that was subsequently replicated on 4 East of the North Naples Campus.  We asked two NCH Physician Group hospitalists to physically spend their entire weekdays embedded within the floor.  Prior to this pilot, hospitalist physicians (who care for hospitalized patients) would round throughout the hospital from morning to night, spending a few minutes once a day with a patient.  Families needed to be vigilant to meet with the physician in person, nurses would “catch as catch can” or play telephone tag to consult with the hospitalist, and consulting physicians/support staff would similarly struggle to meet up or speak with the hospitalist. 

 

We also added formal team rounds at 8:30 AM and 3:30 PM with social service, discharge planning, physical therapy, rehab, psychiatry, dietary, pharmacy, and other supportive professionals contributing face-to-face.

 

Geographically locating physicians on units has had multiple, sometimes unexpected, objective positive results.  First, discharge before 11 AM increased markedly.  We then noticed length-of-stay profoundly dropping 0.87 days from 4.91 to 4.04.  From a patient’s point of view, getting better faster is an advantage.  While readmissions are a concern if patients are discharged too quickly, our readmission rate is already 2.2 standard deviations better than average.  Amazingly, thus far, our 30-day readmission rate has dropped from a monthly high of 11.4% to 3.7%.

 

Hospital acquired conditions like pressure ulcers, infections, and falls with injuries also dropped from a few per month (slightly better than average) to almost zero.  We also have much higher throughput in these pilot units.  A pre-dawn weekend conversation with 4 East night Charge RN Alex Lacatus and Unit Secretary Emily Schwab highlighted the accelerated turnover with their night’s experience: fifteen admissions during the night after eleven discharges the day before.  We have effectively increased capacity about a third.          

 

Our initial goal to improve patient experience was stated by a 4 East patient, “The experience has been wonderful, like staying at the Ritz.”  Nine survey scores including “would recommend” and “overall rating” are trending upward.  Moreover, “doctor communication” transiently ranked at 100%—a first for us.  These evaluations, based on surveys sent home about two weeks after discharge by an independent national company reporting to CMS, are completed by the patients or patients’ families.  Feedback from embedded physicians and consultants is similarly positive.  While working harder due to higher turnover, nurses are pleased with the communication and feel good about the care their patients are receiving. 

 

All the positive consequences and better patient experiences of embedding hospitalists in nursing units will spread throughout our system and help everyone live a longer, happier, and healthier life.   

  

P.S.  DO YOU HAVE A COLLEAGUE OR FRIEND WHO WOULD BE INTERESTED IN UPDATES?  Please enter their email address at nchmd.org/straighttalk, and we will add them to our complimentary mailing list.  
AUTHOR

Allen S. Weiss, MD

President and CEO

You may contact Dr. Allen Weiss and The NCH Healthcare System by clicking here.