Interprofessional Collaboration During Discharge Planning for a Large Midwestern Hospital

Introduction: Interprofessional collaboration (IPC) improves the quality of healthcare delivery. IPC enhances communication during discharge planning, through use of structured daily rounds to reduce readmissions, length of stay (LOS), cost, and mortality. A $240 billion reduction in cost could be achieved with IPC. The Joint Commission, Institute of Medicine, and World Health Organization emphasize use of IPC to reduce errors, improve patient outcomes, and refine transitions of care for patients. Objectives: The goal of this project was to determine how IPC within structured daily rounds during discharge planning impacts patient LOS and staff satisfaction. Methods: This quality improvement project was conducted at a large Midwestern hospital on two medical-surgical units. Implementation of structured daily rounds using a toolkit were evaluated. Data were collected via observations of discharge planning, daily rounds, and surveys; while LOS data was provided by the site. Results: LOS was positively impacted by structured daily rounds. Unit A LOS was reduced by 0.09 days while unit B reduced by 0.14 days following implementation. Staff satisfaction and understanding of IPC during rounds improved by 11.3% (62.2% to 73.5%) following implementation. Conclusions: LOS was positively impacted by structured daily rounds. LOS was successfully reduced following implementation. Staff understanding of IPC during daily rounds with the use of a toolkit had a small improvement. The toolkit, along with key stakeholder involvement, were beneficial to enhancing staff satisfaction through improved communication and education. Implications: Practice improvements included structured daily rounds that would include IPC to ensure effective discharge planning and patient needs were met. Utilizing a toolkit enhanced daily rounds and improved uptake for practice change by developing necessary tools for education, audits, and expectations to warrant success and sustainability of structured daily rounds. Patient LOS is expected to further decline after continued use of the toolkit enhances daily rounds and the change in practice becomes the new culture for discharge planning

STREAM Journal, Vol. 6, No. 1, pp 1-21. Jan-March 2007

CONTENTS: Approaches to understanding pond-dike systems in Asia: the POND-LIVE project approach, by Dave Little, Marc Verdegem and Roel Bosma. The contribution of fish ponds to nutrient cycling in integrated farming systems, by P.N. Muendo, J.J. Stoorvogel and Marc Verdegem. Improving the contribution of fishfarming to livelihoods in Northeast Thailand, by Chittra Arjinkit, Roel Bosma, Danai Turongrouang. Benefits of pond-dike systems in Bangladesh, by M.S. Kabir, M.A. Wahab and Marc Verdegem. Common carp increases rohu production in farmers ponds, by Mohammad Mustafizur Rahman, Md. Abdul Wahab and Marc C.J. Verdegem. Improving pond-dike farming systems in the Mekong delta, Vietnam; the Can Tho approach, by Dang Kieu Nhan, Le Thanh Duong, Le Thanh Phong, Roel H. Bosma and Marc C.J. Verdegem. Fuzzy pathways for farm development in Vietnam, by Roel H. Bosma, Le Thanh Phong, and Dang Kieu Nhan

Population Health Solutions for Assessing Cognitive Impairment in Geriatric Patients.

In December 2017, the National Academy of Neuropsychology convened an interorganizational Summit on Population Health Solutions for Assessing Cognitive Impairment in Geriatric Patients in Denver, Colorado. The Summit brought together representatives of a broad range of stakeholders invested in the care of older adults to focus on the topic of cognitive health and aging. Summit participants specifically examined questions of who should be screened for cognitive impairment and how they should be screened in medical settings. This is important in the context of an acute illness given that the presence of cognitive impairment can have significant implications for care and for the management of concomitant diseases as well as pose a major risk factor for dementia. Participants arrived at general principles to guide future screening approaches in medical populations and identified knowledge gaps to direct future research. Key learning points of the summit included: recognizing the importance of educating patients and healthcare providers about the value of assessing current and baseline cognition;emphasizing that any screening tool must be appropriately normalized and validated in the population in which it is used to obtain accurate information, including considerations of language, cultural factors, and education; andrecognizing the great potential, with appropriate caveats, of electronic health records to augment cognitive screening and tracking of changes in cognitive health over time

Additional support for the TDK/MABL computer program

An advanced version of the Two-Dimensional Kinetics (TDK) computer program was developed under contract and released to the propulsion community in early 1989. Exposure of the code to this community indicated a need for improvements in certain areas. In particular, the TDK code needed to be adapted to the special requirements imposed by the Space Transportation Main Engine (STME) development program. This engine utilizes injection of the gas generator exhaust into the primary nozzle by means of a set of slots. The subsequent mixing of this secondary stream with the primary stream with finite rate chemical reaction can have a major impact on the engine performance and the thermal protection of the nozzle wall. In attempting to calculate this reacting boundary layer problem, the Mass Addition Boundary Layer (MABL) module of TDK was found to be deficient in several respects. For example, when finite rate chemistry was used to determine gas properties, (MABL-K option) the program run times became excessive because extremely small step sizes were required to maintain numerical stability. A robust solution algorithm was required so that the MABL-K option could be viable as a rocket propulsion industry design tool. Solving this problem was a primary goal of the phase 1 work effort

A Chronic Obstructive Pulmonary Disease Pilot Using Risk Stratification to Improve Resource Allocation and Reduce Readmissions

Background: Chronic Obstructive Pulmonary Disease (COPD) impacts 250 million people, is associated with high hospital readmission rates, and costs over $50 billion annually. Purpose: Apply risk stratification identifying higher risk patients to prioritize complex, time-consuming interventions and resources. Methods: Patients hospitalized with COPD were risk stratified using PEARL. Moderate-high risk patients were referred to specialty nurse practitioners, who used real-time interventions and motivational interviewing during intense weekly visits over 30 days targeting self-management, patient-specific risks, and resources. Results: No patients were readmitted or died during the pilot using risk stratification with patient-specific tertiary preventive care to communicate resource allocation. Impact: This process provided recommendations for expansion throughout the healthcare facility, other chronic health conditions, budgets and policy for value-based care, and further research

The New Era of Health Care: Catholic Health Initiatives Journey with Bundled Payment for Care Improvement in Total Joint Replacements

This study examined the relationships between total costs of care and total readmission rates for Medicare patients undergoing major joint replacement of the lower extremity (knee/hip arthroplasty) at one of four Catholic Health Initiatives (CHI) facilities participating in both Phase 1 and Phase 2 of the BPCI program by using complete Medicare claims data for beneficiaries. Both univariate and multivariate models were utilized to examine the impact of the BPCI initiative on costs and readmissions. Findings from this study suggest a relationship between Phase 2 BPCI participation and decreased costs. Hospitals participating in the Phase 2 BPCI program had total episode costs that were $3,333 per episode lower than hospitals participating in the Phase 1 BPCI program. There was no statistically significant evidence of decreased readmissions for Phase 2 BPCI participants

Effectiveness of User Centered Design for Optimizing an Electronic Documentation Form

Problem. The electronic form used by lactation consultants to document assessment findings, interventions, plans and recommendations, did not meet user’s requirements. Purpose: The purpose of this project was to evaluate the effect of optimization through a User Centered Design (UCD) process on information quality, use and user satisfaction. Goals. The goals were to provide information technology (IT) support for the organization’s Baby Friendly initiative and to support collaborative, consistent messaging for breastfeeding families which could, in turn, support exclusive breast milk feeding. Exclusive breast milk feeding is a population health initiative that could positively impact the triple aim of better care, lower costs and better health. Objectives. Information quality, use and user satisfaction affect user adoption and acceptance of IT solutions. The objective of this project was to test the effectiveness of UCD on optimization by measuring the increase in information quality, use and user satisfaction after implementation of an optimized electronic lactation assessment. Plan. Stakeholders were identified and the electronic form was optimized through UCD. A pre-test/post-test quasi-experimental design was chosen to measure the effect of optimization. Instruments included a modified version of the System and Use Assessment Survey (AHRQ, n.d.), a chart audit tool and an electronic data warehouse use query. IRB approval was obtained from COMIRB and Regis University. The pre and post data collection periods were each six weeks in length, allowing for a two week chart audit period and four week survey. The intervention was implemented after the close of the pre-test period. Clinical users were educated following the organization’s usual methods for EHR changes. Five months after the intervention, the study timeline was repeated for the post-test period. After the post-test period, a use query was run to collect data for both pre-test and post-test periods. Data were collected, coded, and entered into electronic spreadsheets for storage and analysis. Outcomes and Results. Although the sample as a whole showed no statistically significant increases in any parameter of information quality, use, or user satisfaction, when survey participants were divided by role, nurses and providers, there was a statistically significant increase in the post-test nursing group for two measures of information quality and one measure of information use. A Mann Whitney U test found a significantly higher perception of completeness of the lactation assessment, U = 200, z = -2.11, p = .035, r = .29 and reported frequency of accessing the lactation assessment from the EHR, U= 233, z = -2.01, p = .044, r = 0.26. A Fishers exact test found a statistically significant increase in the presence of lactation assessments in the post-test chart audit [1, N = 39] = 11.8, p =.001, φ= .39). The outcomes may be explained by differences in how each role uses the EHR. Additional education for providers may be necessary to overcome these differences