Creating Effective Discharge Instructions to Reduce

Creating Effective Discharge Instructions to Reduce
Readmissions
Day 1, 11:15-12:15 pm
Kathy Rauch
Quality Performance Advisor
Press Ganey
Learning Objectives
At the conclusion of this program, participants will be able to

Describe the reasons for urgency in improving discharge to reduce reamissions.

Identify common areas where the implementation of discharge teaching.

Identify implementation strategies for discharge teaching throughout your organization.
Criteria for Successful Completion
To receive continuing nursing education contact hours, you need to attend the entire presentation, and
complete and submit an evaluation at its conclusion.
Disclosures
All nurse planners, content specialists, and faculty of the 2013 Press Ganey Regional Education
Symposiums have agreed to present information fairly and without bias, based on generally accepted
scientific principles and methods, and to not promote the commercial interests of Press Ganey during
their presentations.
Press Ganey is the sole provider and sponsor of this event.
Accreditation Statement
This continuing nursing education activity was approved by the American Association of Neuroscience
Nurses, an accredited approver by the American Nurses Credentialing Center’s Commission on
Accreditation. Approval valid through April 21, 2016 AANN Approval Code: 422/21.5/02
© 2014 Press Ganey Associates, Inc.
Effective Discharge Teaching:
A Tool to Reduce Readmissions
Kathleen Rauch, RN, BSN, CPHQ
Quality Performance Advisor
2
1
Objectives
• Describe the reasons for urgency in improving discharge to reduce
readmissions
• Identify common barriers to discharge teaching
• Identify implementation strategies for discharge teaching throughout
your organization
3
Performance Insights
2
Press Ganey Study
Analysis of Inpatient Value-based Purchasing program (VBP)
 Negative association between hospital’s HCAHPS VBP scores and
readmission penalties.
 Very low HCAHPS (0-19) = higher readmissions
vs.
 Very high HCAHPS (80-100) = low readmissions
5
Patient Experience Correlates with Readmissions
6
3
The Relationship Between HCAHPS Performance
and Readmission Penalties
7
Regulatory Overview
4
CMS Quality-Based Payment Reform Initiatives
2010
2011
2012
2013
2014
2015
2016
2017
Inpatient Quality Reporting (IQR)
2% of IPPS APU
Value-Based Purchasing (VBP) 1.75% ‐ 2% baseline DRG
2% ‐ 3% baseline DRG
Readmissions
Hospital Acquired Conditions
1% DRG
HIT & Meaningful Use 25% ‐ 75% APU
Outpatient Quality Reporting (OQR)
2% of OPPS APU
Inpatient Psychiatric Facility (IPF) 2% IPF PPS APU
© 2014 Press Ganey Associates, Inc.
29
Hospital Readmission Reduction Program

Hospitals with readmission rates exceeding the
“expected level” will be subject to Medicare DRG
payment reductions

FFY 2013: payment reduction was up to 1%

FFY 2014: payment reduction up to 2%

FFY 2015 and beyond: payment reduction up to 3%
© 2014 Press Ganey Associates, Inc.
10
5
Patient Suffering – Unmet Discharge Needs





Difficulties with functional abilities
Inability to carry out personal care
Unmet emotional needs
Medication related errors
Failed follow-up care compliance
11
12
6
What are the barriers?
Organizational
Patient
Staff
Process
Readiness
Preparedness
13
Give the discharge process it’s due…
 Develop an organizational discharge process

Identifies key points during admission related to discharge planning
and education and responsible person
– Initial nursing assessment
– Daily activities
– Discharge planning meeting
– Day of discharge
14
7
Discuss Discharge as a Team
Discharge “Time-Out”
 Analogous to the “Preoperative Time Out” used by surgical teams at
the start of a case.
 Use of a checklist
 During interdisciplinary rounds review discharge education needs

Engages other disciplines into the process:
 Pharmacy for poly-pharmacy, or new medication
education needs
 Nutrition for dietary guidance
15
Preparing Staff to be Discharge Educators
Patient
Readiness
16
8
Providing information for Patient
Set‐aside time
• Plan with patient when to do education
• Ask for family members to attend
Eliminate Distractions
• Shut the door
• Create notice for team that it is time for education
Set Expectations
• Establish interactive expectation
• Establish estimated time • Reinforce importance of the time
17
Preparing Staff to be Discharge Educators
Staff
Preparedness
18
9
Staff Need to …
• Information to be delivered
• Techniques to deliver that information
KNOW
BE ABLE
• Demonstrated skills
• Assessment and personalized training based on performance
• Structured accountability
• Clear expectations
PERFORM
19
Increasing Knowledge
Through Effective Training
KNOW
10
Training the “Why”
 Didactic presentation of epidemiology of unsafe discharges and
strategies to improve safety
 Raise awareness
 Help identify areas for systems and individual improvement
21
Training the “Why”

Teaching Accountability at Transitions
 The “bounce back” policy- Is this good for the doctors or the
patients?
 What happens to patient’s after they go home?
 Why do patient’s “fail” at home?
 Why do readmissions occur and what can we do to prevent them?
22
11
Training to Overcome Challenges
Patient suffering may create education challenges
Patient’s can become resistant
Physical and emotional stress of illness
Identify core concerns
Fear, pain, misunderstanding
Address concerns
Consult with other health care team members as needed
Engage the patient’s family members when possible
Emphasize the benefits of education instead of nagging the patient
23
Key Components of How to Provide Effective
Patient Discharge Education
EVALUTE
PLAN
Implement
• Literacy, language, means of learning
• What are the needs and concerns?
• Specific, Measurable, Attainable, Realistic, and Time‐bound
• Building bridges‐ the balance of needs and concerns
• Maximizing teaching moments
• Continually reassess
• Provide a good learning environment
• Consistent and simplistic 24
12
Train to Reassess
Ask Me 3
• What is my main problem?
• What do I need to do?
• Why is it important?
Teach‐back
• Tell me…
• Press Ganey resources on teaching teach‐back available–
Return Demonstration
• Show me…
25
Train to Document
26
13
Assessing Ability Through
Competency Testing
BE ABLE
Testing Competency – Role Playing
Create patient education as a core annual competency for all direct
patient caregiver staff

Use role playing for training
 Focus on learning objectives
 Provide more than one opportunity to practice
 Assess performance
 Debrief and provide feedback
28
14
Just In Time Coaching
Engages staff by providing real-time-feedback
Positive or negative
Allows for reinforcement of best practices, policies and
procedures
Provides staff with training when they need it…not weeks
or months later
Eliminates the need for refresher training due to loss of
newly acquired skills
29
Accountability to Insure Performance
PERFORM
15
Leader Rounding for Accountability
Round
Evaluate patient’s understanding and experience with education
Assess
Assess if it meets the standard established
Coach
Coach staff on the positives and negatives of what you learned in your rounds
31
Supporting Your Staff to Success
16
Make Tools Available
 Printed materials, video or audio, or tactile materials, ie. Medications
 Patient education publishers provide information on patient
education techniques and practices.
 Primary language and literacy level
 Make sure the resources are up-to-date
 Disease-specific or voluntary organizations may provide materials.
 Look for inconsistencies between your goals and those of the
materials
33
Considerations of Tools
 A clear focus and goals
 Headings that present key concepts for busy, scanning, or lowliteracy readers
 Step-by-step instructions
 Practical tips to improve daily living
 A clear language level that matches the bulk of your patients
 Translations if your patient population warrants it
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17
Benefits of Effective Education
Increased Compliance
Patient Outcomes Utilization
Informed Consent
Satisfaction
35
This is why we really do it
36
18
Questions?
19

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