improving transitions from acute care to rehab: … · • across 7 acute care hospitals* (and...
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IMPROVING TRANSITIONS FROM ACUTE CARE TO REHAB:
SPREADING CHANGE ACROSS GTA HOSPITAL SITES FOR PATIENTS POST-HIP FRACTURE GTA Rehab Network
Charissa Levy, Sharon Ocampo-Chan, Donna Renzetti October 2016
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PROBLEM How can we access rehabilitation programs as early as possible to facilitate the
recovery of patients following hip fracture across the system?
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PROJECT AIM To standardize and enhance access to
rehabilitation post-surgery for patients post-hip fracture across participating
hospitals, with the goal of reducing the acute care length of stay from surgery to discharge (to inpatient rehab program) to an average of 6 days by December 2016.
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OUR CHANGE STORY…. We decided to spread an
Early Patient Referral Model and other learnings of the
original IDEAS project team* on patient flow for hip fracture
* Acknowledgement: − Jane Harwood, Michael Garron Hospital − Mandy Lau, Providence Healthcare − Jackie Eli, Bridgepoint – Sinai Health System
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BARRIERS “Why is the rehab application declined?”
“What can rehab programs manage medically?”
“What information is needed in the rehab application?”
Tools were developed to facilitate referral process improvement.
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NEEDS ASSESSMENT We asked the Project Leads of acute care and rehab sites to identify their team strengths, current referral practices, needs & mitigation strategies to facilitate implementation of the Early Patient Referral Model.
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CHANGE IDEAS Acute care: • Complete & send rehab
application by day 3 after surgery
Rehab: • Respond within 1 day • Consider patient’s premorbid
functional status
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Average LOS from admission to surgery
• Date of admission
• Date of surgery
Average LOS from surgery to sending rehab application
• Date of surgery
• Date rehab application sent by acute care
Average LOS from sending rehab application to receiving rehab response
• Date rehab application sent by acute care
• Date of first response by rehab
Average LOS from receiving rehab response to discharge
• Date of first rehab response
• Date of acute care discharge
OUTCOME MEASURE Average Length of Stay (LOS) from Surgery to Acute Care Discharge
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PROCESS MEASURES • Referrals sent by day 3
following surgery • Referrals with 1 day rehab
first response time • Referrals with Requests for
Information. What info requested?
• Referrals Declined. Why declined?
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BALANCE MEASURES • % patients returning back to acute
care from rehab • Functional outcome & discharge
destinations of patients after rehabilitation
• Length of stay in rehab programs • Patient Experience Questionnaire
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82%
72%
63%
51% 48%
42%
34%
0%
20%
40%
60%
80%
100%
G (3 months) B (8 months) D (16 months) C (11 months) E (8 months) F (3 months) A (10 months)
Rehab
HOSPITAL
HIGHLIGHT: PROCESS MEASURE Proportion of patients that met the Project AIM of
surgery to acute care discharge ≤ 6 days (from April 2015 to July 2016)
7 acute care hospitals: Credit Valley Hospital – Trillium Health Partners (THP), Etobicoke General Hospital – William Osler Health System, Humber River Hospital, Mississauga Hospital - THP, North York General Hospital, St. Joseph’s Health Centre, The Scarborough Hospital – General site
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Average
8.8 days
UCL
LCL
2
4
6
8
10
12
14
Oct '15(n=8)
Nov '15(n=5)
Dec '15(n=7)
Jan '16(n=6)
Feb '16(n=*)
Mar '16(n=6)
Apr '16(n=10)
May '16(n=6)
Jun '16(n=9)
Jul '16(n=15)
Project Aim ≤ 6 Days
Hospital A
Average
5.2 days
UCL
LCL 0
2
4
6
8
10
12
14
Oct '15 (n=*) Nov '15 (n=*) Dec '15 (n=*) Jan '16 (n=7) Feb '16 (n=*) Mar '16 (n=*) Apr '16 (n=*) Jun '16 (n=*)
Day
s
Project Aim ≤6 Days
Hospital B
Average
7.2 days
UCL
LCL
0
2
4
6
8
10
12
14
16
Sept '15(n=5)
Oct '15(n=6)
Nov '15(n=7)
Dec '15(n=7)
Jan '16(n=8)
Feb '16(n=9)
Mar '16(n=*)
Apr '16(n=*)
May '16(n=*)
Jun '16(n=9)
Jul '16(n=5)
Day
s
Project Aim ≤6 Days
Hospital C
Average
6.7 days
UCL
LCL
-4
-2
0
2
4
6
8
10
12
14
16
Apr '15(n=*)
May'15
(n=*)
Jun '15(n=5)
Jul '15(n=*)
Aug '15(n=*)
Sep '15(n=14)
Oct '15(n=*)
Nov '15(n=*)
Dec '15(n=5)
Jan '16(n=5)
Feb '16(n=6)
Mar'16
(n=*)
Apr '16(n=*)
May'16
(n=*)
Jun '16(n=*)
Jul '16(n=6)
Day
s
Project Aim ≤6 Days
Hospital D
Day
s
HIGHLIGHT: PROJECT OUTCOME • Across 7 acute care hospitals* (and rehab partnerships),
319 patients discharged to rehab programs achieved an average of 7.6 days LOS from surgery to discharge since implementation from April 2015 to July 2016.
• The average first response time across 5 rehab hospitals** was 0.4 days.
*7 acute care hospitals: Credit Valley Hospital – Trillium Health Partners (THP), Etobicoke General Hospital – William Osler Health System, Humber River Hospital, Mississauga Hospital - THP, North York General Hospital, St. Joseph’s Health Centre, The Scarborough Hospital – General site **5 rehab hospitals: Baycrest, Providence Healthcare Centre, Runnymede Healthcare Centre, St. John’s Rehab – SHSC, West Park Healthcare Centre
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MOST POSITIVE OUTCOME Enhanced communication and
collaboration across acute care and rehab partnerships.
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SUSTAINING IMPROVEMENT • Reporting back to project sponsor • Continue regular partnership meetings • Monitor performance
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SPREAD • To internal rehab programs • Lessons learned shared through provincial
webinar with IDEAS Alumni • Exploring application to other patient
groups
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LESSONS LEARNED • ↑ celebration of small successes with project teams • ↑ focus on qualitative benefits observed • Engaging project lead/sponsor earlier to obtain a longer
baseline performance
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WHAT’S NEXT • Continue to support partnerships
through quarterly meetings • Analyze audit referral process data
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COST SAVINGS Six of seven hospital sites have achieved or are close to achieving the Project
AIM of six days as the average length of stay from surgery to discharge
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USE OF AWARD FUND Hired an Analyst to help with monthly referral process data analysis across partnerships.
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Participating Acute Care: Credit Valley Hospital – Trillium Health Partners (THP), Etobicoke General Hospital – William Osler Health System, Humber River Hospital, Mississauga Hospital - THP, North York General Hospital, St. Joseph’s Health Centre, St. Michael’s, Sunnybrook Health Sciences Centre, The Scarborough Hospital Participating Rehab: Baycrest, Bridgepoint – Sinai Health System, Credit Valley Hospital - THP, Humber River Hospital, Mississauga Hospital - THP, Providence Healthcare, Runnymede Healthcare Centre, St. John’s Rehab – Sunnybrook, William Osler Health System, West Park Healthcare Centre Other organizations supporting participating sites: Michael Garron Hospital, Mount Sinai – Sinai Health System, Toronto Western Hospital – UHN, Toronto Rehab - UHN
St. Joseph’s Health Centre
Baycrest
Mississauga Hospital
North York General Hospital
Credit Valley Hospital
West Park Healthcare Centre GTA Rehab Network Etobicoke General Hospital Runnymede Healthcare Centre