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Using Analytics to Reach The Triple Aim

April 13, 2015

Lori Beucler, MSN, RN, BC-NE Shailesh D. Patel, MD Vice President and Chief Nursing Officer Medical Director, Department of Anesthesia

DISCLAIMER: The views and opinions expressed in this presentation are those of the author and do not necessarily represent official policy or position of HIMSS.

Conflict of Interest Lori Beucler MSN, RN , BC-NE Vice President and Chief Nursing Officer, Susquehanna Health Has no real or apparent conflicts of interest to report. Shailesh D. Patel, MD Medical Director, Department of Anesthesia Has no real or apparent conflicts of interest to report.

© HIMSS 2015 2

Learning Objectives After attending this session, participants will be able to: 1. Identify the improvements in care quality, patient experience, efficiency and

value that can be achieved using perioperative data analytics in a multi-site health system to achieve Triple Aim outcomes.

2. Use data analytics to create and sell the business case for a redesigned OR throughput process that improves the patient care experience and improves revenue.

3. Outline steps necessary to use data analytics for process changes that impact care models, efficiency gains, patient experience/satisfaction and financial value.

4. Describe the specific challenges of implementing a data analytics program in the OR, and how these challenges can be addressed.

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About Susquehanna Health

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About Susquehanna Health

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Value Steps

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P

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SATISFACTION Helps organizations achieve patient, provider & staff satisfaction

TREATMENT/CLINICAL Leverage data analytics to improve quality of care

ELECTRONIC INFORMATION/DATA Comparative & deep-dive data in e-dashboards & reports guide decision-making PREVENTION & PATIENT ED

Track and monitor patient data to improve population health SAVINGS

Utilize comparative data to support decision-making regarding purchasing and operations

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Clinical - quality of care Financial - productivity, spending & revenue Operational - work flow processes

Leveraging Data in Perioperative Services

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Where do you start?

SCIP PACU times

patient throughput

care transitions

productivity service lines

antibiotic administration

time out

surgeon scorecard

turnover time

on-time starts

quality metrics

patient satisfaction

staff satisfaction

pre-admission testing

material costs

implants

sterile processing

scheduling

block utilization

cost per case

overtime

staffing scenarios

charges

workflow processes purchasing

emergent cases revenue cycle

Leveraging Data to Shoot for Triple Aim

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Big Data- High Impact Improvement

»Surgical Services – Integral component of every hospital

»OR leadership Mission »C-Suite message

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Developing Your Strategic Plan – High-impact Data Analysis:

• Clinical - ? negative outcomes • Process improvement - ? performance gaps • Financial - ? Margin erosion

– Hunt for Variations: • What is the data suggesting

– Metrics that differed from expectations • Go for shock and awe

–Maybe the rock star surgeon doesn't really rock….

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Susquehanna Data Driven Initiatives

Patient, Family, Staff & Physician

Satisfaction

Patient Safety & Core

Measures

Revenue Cycle &

Productivity

Inventory & Charge Capture

New Technology

& Supply Chain

Management

Patient Throughput

Methodologies

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Patient Experience – Operational Issues Goal: Fix Patient Throughput

• Challenge: Gridlock

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Patient Throughput Deep dive on the analytical data:

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• Pre-op wait times often > 240 minutes (SDS to Wheels In)

• Pre-op holding time often > 180 minutes

• PACU post-op holding >300 minutes • Patient satisfaction related to wait time-

low of 80.1%

Patient Throughput: Process Challenges • Pre-op - Problems

• Lack of pre-op beds, waiting space • Moved patients 4 times prior to surgery • Teams worked in silos, Provider focused

•OR - Problems • PACU full; recovering patients in the OR • Creating massive case delays, long patient

waits, provider frustration • PACU - Problems

• Lack of PACU and in-patient or SDS beds • Lack of transporters

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Data Driven Goals: Reduce waiting times Create a patient-centered care environment Improve PACU throughput Improve OR case start time Improve patient/staff/surgeon satisfaction Improve productivity

Data Driven Business Case •Developed proposal to create new space:

• Created patient centric care model • Changed from provider focus to patient focused • Improve:

– Throughput of ED – Throughput of post-op patients to in-patient – Access to surgical schedule – Productivity of all providers – Patient Satisfaction

• Increase revenue & avoid waste

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Early Results

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Triple Aim: Population Health - Clinical Goals • Challenges: Improve overall health of the patients we serve

– Improve SCIP compliance, eliminate surgical site infections – Reduce LOS & readmissions, improve compliance with post-

operative care/instructions

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Triple Aim: Clinical •Challenge: •Standardize Care to ensure consistent, efficient, safer, and higher quality care across patient populations

•Data demonstrated opportunity for improvement :

– Compliance with SCIP measures – Undesirable rate of post-op infections – LOS higher than national

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Triple Aim: Clinical Results • 30 day surgical readmission Significantly less than national average

• Wrong patient events: ZERO

• ALOS : Ortho Decreased From 4.9 to 3.1 Hips and Knees

• SCIP: 100th percentile for all measures Quality Insight Innovation Award:

Improvement of Surgical Site Infections

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Results: Surgical Site Infections

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2011 2012 2013 2014Total SSI 50 50 46 26

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Volu

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Annual SSI Amount

2011 2012 2013 2014SSI Rate 0.90 0.54 0.48 0.26

0.000.100.200.300.400.500.600.700.800.901.00

Perc

ent

Annual SSI Rate

Triple Aim: Reducing Costs - Financial

•Challenge: Improve Efficiency of each campus OR and Reduce Costs

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Maximize efficiency via process change

• But first…analyze & fully understand the data! • The data (evidence) will lead you to the right

decisions…. – Three examples

• Campus Raw and Adjusted Utilization • Utilization by admission type (OP vs. IP) • Implant utilization and vendor

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Activity and Staffing Resources: Single Critical Access Hospital

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Off Shift Count by DOW

Off-shift case volume

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Plan • Share data with stakeholders

–Save $$ by reducing call –Releases surgeon from 24/7 call

responsibility –Releases Anesthesia from 24/7

coverage –Off-shift cases move to different

facilities

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• Savings –Saved $100,000 at one campus alone –Reduced costs related to anesthesia

coverage –Resolved issues with general surgeon

availability –OR team, surgeons and anesthesia :

Triple Aim: Financial Results

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• - Jan Fisher, COO

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Orthopedics: Implant and Scheduling Efficiencies Using data analytics from OR case record ran reports to understand: Varied implants utilized by surgeon by case type by manufacture/vendor by cost

Surgeon 1 Surgeon 2 Surgeon 3 Surgeon 4 Surgeon 5 Surgeon 6Inpatient 209 66 299 443 74 174Outpatient 241 217 171 193 280 243

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150

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450

500

Volu

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Orthopedic Admit Status Dec 2013 - Nov 2014

Creating efficiencies in OR Utilization by Case type

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Data led us to the plan…….

Top three producers of OP volume Open time at SDS Center Shifting required no change to provider schedules Re-allocate blocks to Wiliamsport Regional

Medical Center for IP volume Results: Increase access to OR schedule Improved productivity of teams Decrease patient wait time Improve patient satisfaction

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Results of Leveraging Data Analytics New patient flow model eliminated up to 90

minutes of wait time Increased patient satisfaction from 94% to 98% Created powerful business intelligence resulted in

a $360,000 savings in orthopedic implant costs Eliminated under-utilized, non-profitable services

- -- $100K savings in call coverage Standardization in care protocols Application to AQI (currently in progress) Provided National benchmarking for supply cost,

surgical outcomes and profitability

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Today’s take-home tips…How to leverage YOUR Data…… Maximize Analytics in your EMR Don’t have a tool? Invest in the best! Re-engineer your admin team

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Accuracy of data input

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Pre-analytics process mapping

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Win with PARTNERSHIPS!

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Statistical significance

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Triple Aim: Shoot for the Stars

Maximize every opportunity, Maximize use of your tools, Maximize Success! EXECUTE……….

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Analytics ……

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See the Future

Value Steps

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T

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P

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SATISFACTION Helps organizations achieve patient, provider and staff satisfaction: • New OR throughput model eliminated up to 90 minutes patient wait time and enabled more patient time with

family, thus increasing patient satisfaction scores to the 98th percentile

TREATMENT/CLINICAL Leverage data analytics to improve quality of care: • Reviewed clinical data across the OR to ensure highest quality standards are in place • Targeted and revamped inefficient processes to enable more patient care time at the bedside

ELECTRONIC INFORMATION/DATA Comparative and deep-dive data in e-dashboards and reports to help guide decision-making: • Integrated data from various sources to provide a comprehensive view of perioperative services to ensure

informed decision-making • Data analytics by provider or staff member, OR room, patient, diagnosis and other key metrics to facilitate

clinical, administrative and financial decision-making across various leadership

PREVENTION & PATIENT EDUCATION Track and monitor patient data to improve population health: • Support application to Anesthesia Quality Institute, thereby leveraging one of the nation’s largest

quality improvement databases for anesthesiologists seeking to assess and improve care • Review clinical data by diagnosis or population to further refine care protocols

SAVINGS Utilize comparative data to support decision-making regarding purchasing: • Evaluate and better negotiate contracts for anesthesia gases, implants and other OR

materials, leading to a savings of $360,000 in FY14 orthopedic implant costs • Compare pricing of implants for more informed discussions with vendors • Leverage analytics for better vendor negotiations to help lower overall cost of care

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Questions

Shea D. Patel, MD • spatel@susquehannahealth.org

Lori Beucler

• lbeucler@susquehannahealth.org

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