Final Report April 11 2017 Team 4 Will Farmer Anna Munaco Esha Sondhi Maggie Steele University of Michigan Comprehensive Stroke Center Introduction Client Jenevra Foley Operating Director of Stroke Clinic ID: 619459
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Improving the Discharge and Post-Discharge Process FlowFinal ReportApril 11, 2017
Team #4Will Farmer, Anna Munaco, Esha Sondhi, Maggie Steele
University of Michigan Comprehensive Stroke CenterSlide2
Introduction
Client
Jenevra
Foley, Operating Director of Stroke Clinic
Coordinators
Kevin
DeHority
, MQS Lean Coach
Andrea Case, Administrative FellowSlide3
Background
Patient deemed ready for discharge
Discharge disposition
identified
Home with Outpatient Rehab
Inpatient Rehab Facility
Follow-up 7-day call from Stroke Coordinator
Follow-Up AppointmentSlide4
Project Scope
Ischemic Stroke Patients
Discharged to Inpatient Rehabilitation Facility (6A)
Discharged to home with outpatient rehabilitationSlide5
Goals and Objectives
Create current state workflow
Analyze and identify barriers and waste
Provide an A3 picture story
Provide a summary of improvement opportunities
Primary Goal
Improve the discharge process of stroke patients at the Comprehensive Stroke Clinic by streamlining the steps involved in the discharge and follow-up processesSlide6
Expected Impact
Expected Impact
Less Rework
Enable Future Process Monitoring
Improved Data Collection Process
Improved CommunicationSlide7
Methods
Literature Search
Interviews and Observations
Historical Data Analysis
Flow Chart
A3 Report and A3 Picture Story Slide8
FindingsSlide9
Literature Search
Future State of this Project
Six Sigma AnalysisSlide10
Insufficient Data
Require sample size of 377 for 95% CI 5% Error
Unable to find correlations between attributes and issuesSlide11
Lack of Standard Workflows
Post-Screening Social Work Involvement
Timing of Medical Insurance Clearance
Notification of IRF Bed Required
Notification of IRF Bed Availability
Search for Outside BedsSlide12
Unresolved Issues at 7-day Phone Call
15.2% of all calls are “Normal”Slide13
Unresolved Appointment Issues Slide14
Unresolved Issues at 7-day Phone Call
Appointments
Nursing Advice
Consultations
Unable to Reach
Referrals
Called more than once
Unresolved issues discovered at 7 day phone call
Stroke
Neurosurgery
Bridge
Reschedule
New PCP
Opthy
Fatigue
Smoking
Medication
Insomnia
Case Managment
Nurse
NP, PA
Social Work
Physician
Therapies
ACTSlide15
Monitors and updates patient admission list
Rearranges patient rooms to maximize capacityManages sending a patient to outside facilities
Schedules patient follow-up appointments
Manages ACT monitor equipment order and placement
Key Staff Roles Have No Cross-Coverage
Resident Assistant
IRF Admissions CoordinatorSlide16
Handoffs Leading to Confusion
Insufficient understanding of other’s roles
Lack of standard work responsibilities
No use of checklists
To IRF
To Home
4A Physician
4A Nursing
4A Care Manager
4A Administration
4A Stroke Coordinator
OT/PT
4A Physician 4A Nursing IRF Administration
IRF Consult Team OT/PT Slide17
Gaps in Continuity of Patient Care
Lack of timely and accessible stroke education resources
Patients left without adequate access to education resources
Confusion over patient ownership between discharge and follow-up
Lack of triage algorithm for patient questions and concernsSlide18
Communication Gaps and Transparency
Stroke Rounds
Underutilization of MiChartSlide19
Baseline Discharge Data Findings
Not Meeting Target
In Control
Not Meeting Target
In Control
Not Meeting Target
In Control
Mean assessment
Variability assessment
Critical Time Metric
Discharge to Follow Up
Discharge Order to Discharge
Writing a Discharge NoteSlide20
On Target
In Control
Not Meeting Target
In Control
Not Meeting Target
In Control
Mean assessment
Variability assessment
IRF Admissions Data Findings
Critical Time Metric
Medical Clear to Admit
Consult to Admit
Discharge Order to DischargeSlide21
RecommendationsSlide22
Collect Additional Data
Metric
Problem
Owner
Follow up phone call date
Insufficient Sample Size
Stroke Center
Follow up phone call issues
Insufficient Sample Size
Stroke Center Readmittance to IRF Date
Insufficient Sample SizeStroke CenterInsurance Clearing Time Unmeasured Metric
IRF Admissions Time on IRF Admissions List Unmeasured MetricIRF Admissions
Time to Outside FacilityUnmeasured MetricIRF Admissions Slide23
Communicate Roles and Responsibilities
Reduce tension and lack of understanding between roles
Show the need for standardization and communication Slide24
Make Resources More Robust and Accessible
Assign Heartcare learning modules
Emphasize importance of binder to patients and caregivers
Add Education Resources to Patient PortalSlide25
Delineate Patient Ownership during Follow-up Process
Patient is discharged from Unit 4A/4AS to home
Patient attends follow-up appointment
Develop triage algorithm and response time goalsSlide26
Cross-train Staff on Key Roles
Resident Assistant
IRF Admissions CoordinatorSlide27
Incorporate Standardized Communication Between Unit 4A and IRF Consult Team
Additional Huddles
Update Discharge Dates DailySlide28
Thank you! Questions?
Team #4Will FarmerAnna MunacoEsha SondhiMaggie Steele