Pursuing High Value

Healthcare

Optimizing Laboratory TestingWebinar #6

July 16, 2015

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Agenda

WelcomeData Team Updates

Current data and reports Discussion

Team Status Reportso Progress/Activities Since Learning Session

Phase 2 of Collaborative Meeting Time Reminders●Next Steps

Action Period

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Our First Collaborative: Global Aim

We aim to reduce harm to patients and conserve system resources by optimizing the use of laboratory tests for patients cared for in our region’s hospitals.  We will use a collaborative approach considering the best medical evidence and quality improvement science.  It begins with an evaluation of current test ordering profiles and patterns followed by an organized plan to optimize testing and ends with a plan to sustain these practices.  By doing this we expect to reduce cost and improve satisfaction and quality of care for patients and the health system.  It is important to work on this now because as health care professionals we can play an important role in health care reform by designing more patient-centered, efficient and high value inpatient care.  

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Data Update

Site visit findingsInstitution specific data reportsConsolidated database reportsNext steps

Project Target Population

All adults with an inpatient hospital stay > 24 hours in length, excluding maternity, inpatient psych and swing bed patients

What does “inpatient” mean? When does admission time start?Inpatient > 24 hoursER visit > 24 hours?Observation bed > 24 hours?Same Day Surgical care > 24 hours?ER Observation Inpatient?

Project Target Population

All adults with an inpatient hospital stay > 24 hours in length, excluding maternity, inpatient psych and swing bed patients

Excluding PatientsMaternity & childbirth related, excluded using MDC codes 14 & 15 or

DRG codes 765-795Inpatient psych, excluded prior to data submission when possible.

Additionally, excluded using DRG code 885Swing bed, excluded using discharges with no DRG code assigned

Dropping Missing DRG codes

Swing bed patients are typically not assigned a DRG codeWhat other patients are typically not assigned a DRG code?

Observation only patients? Other?

What patients might we inadvertently drop if we exclude all discharges with a missing DRG code? DISCUSSION

Defining Length of Stay

Length of Stay in hours = (discharge timestamp – admit timestamp)

Length of Stay in CDC days = (discharge date – admit date)

Length of Stay in calendar days = ((discharge date – admit date) + 1)

Defining Length of Stay

For example, suppose a person gets admitted at 10:02am on June 2nd and discharged at 4:10pm on June 3rd

Length of Stay in hours = (6/3/2014 16:10 – 6/2/2014 10:02) = 29.13 hours

Length of Stay in CDC days = (6/3/2014 – 6/2/2014) = 1 day

Length of Stay in CDC days = ((6/3/2014 – 6/2/2014) + 1) = 2 days

Defining Length of Stay

For example, suppose a person gets admitted at 10:02am on June 2nd and discharged at 4:10pm on June 3rd

But what does “admitted” mean?Was the patient admitted to the ER at 10:02am?Was the patient assigned a bed as on “observation” patient at

10:02am?Was the patient admitted as an inpatient at 10:02am?

Defining Admit Time

1. Identify individual discharges using a unique visit number in the admission data file, unique visit

number

2. Link all labs associated with an individual discharge unique visit numbers

Sometimes the unique visit number is in the Lab data file Sometimes we link on MRN and dates of service

3. Labs are associated with a visit if they are within 24 hours of the available admit timestamp

Labs Within 24 hours of Admit Timestamp

Goal: to ensure we obtain labs that were collected when a patient was in the ER or an observation bed prior to being admitted as an inpatient If labs were collected within 24 hours prior to the available

admit timestamp, the earliest collection time is used as the “admit time” when calculating length of stay

For example, suppose a person goes to the ER on June 2nd at 6:11am and has a CBC drawn at 8:01am. The patient then gets admitted as an inpatient at 10:02am on June 2nd and discharged at 4:10pm on June 3rd. The “admit time” used to calculate length of stay will be 6/2/2014 08:01.

Labs Within 24 hours of Admit Timestamp

By only including labs that were collected within 24 hours prior to the available admit timestamp, what issues might come up?

If a patient has labs for an elective surgery done 7 days prior to the admission they will not be included. BUT if the are done the day before surgery they might be….. Other concerns? DISCUSSION

CBC rates per patient day (HGB)

CHEM rates per pt day (CREAT)

CHEM rates per pt day (K)

CBC rates per first 24 hours of visit (HGB)

CHEM rates per first 24 hours of visit (CREAT)

CHEM rates per first 24 hours of visit (K)

Next Steps

1. Finalize length of stay definitions2. Finalize inclusion/exclusion criteria3. Support sites to continue monthly data uploads4. Define monthly DRG severity values5. Include LFT and Cardiac Biomarker lab tests6. Support Year 2 of the Collaborative (explore lab values?

Explore DRG specific ordering patterns?)

Team Progress Reports

RRMCBrattleboroNVRHBenningtonPorterDHMCCVMCUVMMC

Any updates from the teams to share on advances since our Learning Session at Dartmouth?

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24

Learning Session 1Oct. 25

8:30 to 3:30

LearningSession 4Jun. 9 TBD

8:30 to 3:30

Learning Session 2

Jan.14, TBD8:30 to 3:30

Kick-Off Week 1

Sept 10, 2PM

LearningSession 3

Apr. 14 TBD8:30 to 3:30

Action Period5-6 weeks

Conference Call /

WebinarNov 19,

2PM

Conference Call /

WebinarDec 17,

2PM

Conference Call/

WebinarFeb. 18,

2PM

Conference Call /

WebinarMar 24,

2PM

Conference Call /

WebinarMay 12,

2PM

Continuous Coaching/Faculty Support

Coll

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Tim

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Next Steps

Action Period Continue to review and submit data Test change ideas Measure results Adjust as needed Test again or try new change idea

Support Faculty and Data Team are here to support you!

Next Webinar- August 13th, 2PM

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