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Increasing your Value-Based Purchasing Score through 5 Patient Rounding Best Practices

  1. Increase Your Value-Based Purchasing Score With 5 Patient Rounding Best Practices Jeff Echternach, Carilion Clinic Carol Haney, Qualtrics
  2. Senior Operations Consultant, Carilion Clinic For Carilion Clinic, a non-profit health system based in Roanoke Virginia, Jeff lead an organization-wide implementation of rounding tools, starting with Patient facing satisfaction and safety rounds and later including Staff Rounding and Compliance and Audit (non-patient) rounding. Since inception, almost 200,000 rounds have been completed and sustained results including: improvement in HCAHPS, a reduction in HAI, namely Catheter Associated Urinary Tract Infections (CAUTIs). Rounding efforts have exposed improvement opportunity in a variety of areas and the use of data and actionable follow-ups have translated to improvement. Jeff Echternach
  3. Senior Research and Data Scientist Carol Haney’s principal research area is online quantitative research, specifically sampling, methodological best practices, and advanced analytics. Carol currently works with multiple clients in the healthcare spaces. Carol has experience running large survey programs that involve segmentation, patient and customer experience, brand communications, and performance measurement. Carol Sue Haney
  4. 4 ©2015QUALTRICSLLC. oDetail the steps to designing a patient rounding experience oDescribe key steps that hospitals should consider when implementing a rounding tool oUnderstand the impact that rounding programs can have on your Value Based Purchasing Score Make a Plan PX VALUE-BASED PURCHASING End User Focus Drive Actions Evaluate Create Account- ability Objectives
  5. 5 ©2015QUALTRICSLLC. Use data to create accountability Make a Plan PX VALUE-BASED PURCHASING End User Focus Drive Actions Evaluate Create Account- ability Design for your end users Make a plan and design your experience Evaluate areas of opportunity with change agents Drive actions and facilitate connections 5 Key Steps 1 2 34 5
  7. 7 ©2015QUALTRICSLLC. VBP Program The Hospital Value- Based Purchasing (VBP) Program is a CMS initiative that rewards hospitals with incentive payments for the quality of care they provide to Medicare beneficiaries.
  8. 8 ©2015QUALTRICSLLC. Understanding VBP o Where can a rounding tool have a meaningful impact o Within patient experience o Within Clinical Care o Importance of scoring and evaluation
  9. 9 ©2015QUALTRICSLLC. VBP Measurement across Domains Right now, we are being evaluated for how we will be paid in the federal fiscal year of 2019
  10. 10 ©2015QUALTRICSLLC. VBP-based Withholding FY2017 is the first year where up to 2% of payment may be withheld
  12. 12 ©2015QUALTRICSLLC. VBP Program o Implementing a rounding tool requires leadership buy-in at all levels o Mapping the journey will allow you to maintain and measure engagement o Review your data with your Quality and Operational department o Invite key leaders
  13. 13 ©2015QUALTRICSLLC. Reviewing your data o HAI/HAC (CAUTI CLABSI, MRSA CDIFF) o PSI-90 composite o Select SSI Compliance post-operative care/ o HCAHPS o Patient Complaint/advocacy data o RCA findings (Serious and sentinel events) and claim settlements
  14. 14 ©2015QUALTRICSLLC. Invite Key Leaders o Nursing (Various staff and leader levels) o Consider CNO Sponsorship o Emergency Room o Surgical Areas o Various Inpatient units o Physician leadership (consider someone from your larger medicine service(s) o Patient Risk/Advocacy o Quality Department o Ancillary department leaders (key to inpatient) o Therapy o Pharmacy o Bed Cleaning o Environmental Services o Maintenance o Dietary
  16. 16 ©2015QUALTRICSLLC. Make a Plan o Think FMEA: o Outline the areas where you want to improve o Think about the level of impact you could expect o Organize your thoughts in to a logical flow o Think CONVERSATION: o Use an envisioned rounding tool or structured visit by a leader
  17. VBP Impact Issue Identification Safety - CUSP 17 ©2015QUALTRICSLLC. Design your experience Structure your questions and patient interactions in a way that will facilitate an interactive experience
  18. 18 ©2015QUALTRICSLLC. Design your experience Rounding Question HCAHPS Measure ID - HCAHPS Question Are we responding to your call bells in a timely manner? H_COMP_3_A_P-Patients who reported that they "Always" received help as soon as they wanted Has your nurse explained what to expect in your care today in a way you can understand? H_COMP_1_A_P-Patients who reported that their nurses "Always" communicated well How are we doing at managing your pain? H_COMP_4_A_P-Patients who reported that their pain was "Always" well controlled Have all of your medications been explained to you? H_COMP_5_A_P-Patients who reported that staff "Always" explained about medicines before giving it to them Have possible side effects been explained to you? H_COMP_5_A_P-Patients who reported that staff "Always" explained about medicines before giving it to them
  19. 19 ©2015QUALTRICSLLC. Design your experience Rounding Dialogue Prompt VBP Domain I noticed your trash bin is full, I am going to ask our housekeeper to come empty your trash bin and mop in the bathroom H_CLEAN_HSP_A_P-Patients who reported that their room and bathroom were "Always" clean You told me that your bed is not raising up and lowering appropriately. I am going to notify our bed repair team to trade out your bed. H_COMP_3_A_P-Patients who reported that they "Always" received help as soon as they wanted You shared that you were not satisfied with part of your meal yesterday. I have notified Dietary to talk with you about today’s menu options H_COMP_3_A_P-Patients who reported that they "Always" received help as soon as they wanted
  20. 20 ©2015QUALTRICSLLC. Design your experience Rounding Question VBP Domain Observe for central line dressing changed, Dressing is clean and dry, dressing has date last changed clearly marked SAFETY-HAI-Central Line-Associated Bloodstream Infections (CLABSI) Observe Foley Catheter & Drain line: Line is clear, bag below bladder, tamper evident seal in-tact, area is clean, documentation that site was cleaned each day / today. SAFETY-HAI- Catheter-Associated Urinary Tract Infections (CAUTI) Engage patient in questions about infection control: Are the nurses and doctors washing their hands before and after working with you? SAFETY-HAI- Methicillin-resistant Staphylococcus aureus (MRSA) C. difficile Infections (CDI) Engage the patient in prevention of infection: Are you encouraging your friends, family, and other visitors to wash their hands before and after visiting? SAFETY-HAI- Methicillin-resistant Staphylococcus aureus (MRSA) C. difficile Infections (CDI)
  21. 21 Touch-screen ease, part of the driver of communication between staff and patient
  22. In-Patient Rounding Survey 22 Medications driver questions: • if No is selected on both or either, then triggers are created • if Yes is selected on both, then triggers are not created
  24. 24 ©2015QUALTRICSLLC. End User Focus Who will be performing the round? What device will they use? Device compatibility?
  25. 25 In-Patient Rounding Survey Rounding Tool Link Note: Each unit has a different Nurse Admin and Primary Physician
  26. In-Patient Rounding Survey 26
  27. In-Patient Rounding Survey 27
  29. 29 ©2015QUALTRICSLLC. Drive Action o Address unfavorable scores with escalation, tickets, and service recovery o Engage your patient advocacy department as a collaborative partner in responding to these scenarios
  30. 30 ©2015QUALTRICSLLC. Examples o Environmental Services Create a ticket to come clean the room, empty waste basket, change linen, clean bathroom o Maintenance Address problems in the room such as broken lights, equipment, or hvac issues o Dietary Identify specific issues the patient is experiencing with food selection / delivery (or) identify more complex systematic issues o Therapy Escalate challenges in mobility and prompt for a therapist evaluation or escalate complaints about painful ambulation or ADLs o Pharmacy Escalate areas where patients remain confused about their medications and leverage unit-based pharmacists to address questions
  31. In-Patient Rounding Survey 31 Patient Rounding identified Medications driver question asked Triggers based on follow-up
  32. 32 Trigger one: email and task to Pharmacist
  33. 33 Trigger two: email and trigger to Nurse Admin and Primary Physician
  34. 34 Trigger three: email and trigger to Nurse Admin
  35. 35 Admin View of all events Pharmacist Nurse Admin Primary Physician Facilitate connections o Ticket based scenarios that you can automate or redirect
  36. Overall Ticket Handling, Follow-Up View 36
  37. Single Ticket Handling 37
  38. 38 Email Sent, with link to dashboard
  39. 39 Building the Events
  40. 40 Overall Ticket Handling, Reminder View Build
  41. 41
  42. Q&A Trigger #1 Example
  44. 44 ©2015QUALTRICSLLC. Data-driven decision making o Use data to create accountability o Dashboards and accountability reports are key o Align process measurement (your rounding tool) with outcome measures (HCAHPS, VBP Scoring on Safety (CAUTI, CLABSI, Etc)) o Review data with your front line staff
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  46. 46
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  48. 48 Dashboard View, all open tickets
  49. 49 Dashboard View, specific ticket handling
  50. 50 Dashboard View, setting root cause on specific ticket (changes per ticket owner)
  51. Q & A

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