Screening Pediatric Patients for Readmission Risk
Transcript of Screening Pediatric Patients for Readmission Risk
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Children's Mercy Kansas City Children's Mercy Kansas City
SHARE @ Children's Mercy SHARE @ Children's Mercy
Presentations
2019
Screening Pediatric Patients for Readmission Risk Screening Pediatric Patients for Readmission Risk
Sarah Bradshaw Children's Mercy Hospital, [email protected]
Blair Buenning Children's Mercy Hospital, [email protected]
Anita Powell Children's Mercy Hospital
Follow this and additional works at: https://scholarlyexchange.childrensmercy.org/presentations
Part of the Pediatrics Commons
Recommended Citation Recommended Citation Bradshaw, Sarah; Buenning, Blair; and Powell, Anita, "Screening Pediatric Patients for Readmission Risk" (2019). Presentations. 24. https://scholarlyexchange.childrensmercy.org/presentations/24
This Presentation is brought to you for free and open access by SHARE @ Children's Mercy. It has been accepted for inclusion in Presentations by an authorized administrator of SHARE @ Children's Mercy. For more information, please contact [email protected].
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© The Children's Mercy Hospital 2017
Screening Pediatric Patients
for Readmission Risk
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Sarah Bradshaw, MSN, RN, CPN, ACM-RN
Blair Buenning, MSN, RN, CPN, ACM-RN
Anita Powell, MA, BSN, RN, BC, ACM-RN
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Experts in Pediatric Care
• Nearly 8,000 employees
• 750+ pediatric specialists
• 2,200 nurses
• 1,000+ allied health
professionals
• More than 900 volunteers
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Our Locations
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The Highest Level of
Care for Kids• 40+ pediatric specialty areas
• Highest level pediatric trauma center
• Highest level neonatal intensive care unit
• Ranked among the best children’s
hospitals in the country by US News
• Honored by the Magnet® Recognition
Program for excellence in nursing
• Leader in pediatric research & innovation
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Hospital Acquired Conditions• Preventable Readmissions
• Central Line-Associated Blood Stream Infections (CLABSI)
• Catheter-Associated Urinary Tract Infections (CAUTI)
• Serious Falls
• Pressure Injury
• Surgical Site Infections
• Venous Thromboembolism
• Adverse Drug Events (ADE)
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Pediatric Readmission Costs
• Cost per event1= $9,540
• Average yearly Medicaid claim for single complex patient = $69,906
• Nationwide annual cost (2015) = $1.5 Billion
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Pediatric Readmission Costs
• Health Risk to Patients (HACs)
• Family Inconvenience
• Unnecessary use of hospital resources
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Case Management Standard of Care
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Screening/ Identification
Through use of identification criteria, stratify patients at risk
AssessmentExpand on knowledge gained by screen and complementary to other disciplines’ assessements
“Case management is expected to have a defined method for
screening/identification and assessment of patients in need of case
management services”
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Screening for Readmission Risk
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Adult Screen Tools
Modified LACE Tool
Pra Risk Tool
Cerner’s readmission stratification score
HOSPITAL Score
Pediatric Screen Tools
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Why Develop a Screen tool?
DecreaseReadmissions
Length of Stay
Emergency Department visits
IncreasePatient/family satisfaction with care
Compliance with national standards of practice & CMS regulations
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Literature Review
➢Identified pediatric risk factors
➢Developed tool based on findings
➢Validated need for tool to look at multiple
factors, not just admitting diagnosis
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Identified Risk Factors
Admitting Diagnosis
Chronic Condition Indicator
Readmission History
Admission Acuity
Insurance
DME Home Nursing Home Therapy Language
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Cycle of QI and ResearchIdentify
the Need
Literature Review
QI
ResearchEvaluation of Results
Formulate plan
Apply next steps
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Gaps Addressed in QI Cycles
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Validity
RELIABILITY of data
Evidence based practice
Lack of documentation/data points available
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QI Project Measures
Outcome100% of admitted
patients will have a screen complete within 24 hours of admission
Process>85% reliability between
Care Managers
Decrease average completion time
100% of fields completed within each
entry
BalancingNurse Care Manager
satisfaction
30-day readmission rate
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Identifying How To Change
1. What are we trying to accomplish?
2. How will we know that a change resulted
in improvement?
3. What change could we make that might
result in improvement?
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Plan – Do – Study - Act
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Implement Tool
Cycle 1
Decrease variability
Cycle 2Focus on
missed populations
Cycle 3
Modify tool
Cycle 4Sustain
results
Cycle 5
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Final Control Chart
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Co
mp
leti
on
Rate
Time
HARRPS Tool Completion Rate within 24 Hours of Admission -Overall Data
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Sustaining Improvements
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Post QI Next Steps → Research
Produce and share
generalizable knowledge
Cross validate findings
Test HARRPS validity and predictive ability in
identifying pediatric
readmission risk
Obtain Institutional
Review Board (IRB) Approval
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HARRPS Tool
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Research Overview
Evaluate
Evaluate each category of tool for validity and reliability
Associate
Associate scores based on statistical findings
Combine
Combine scores to produce a total
Identify
Identify high, moderate, and low risk scores
Validate
Cross validate findings
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Identified Risk Factors
Admitting Diagnosis
Chronic Condition Indicator
Readmission History
Admission Acuity
Insurance
DME Home Nursing Home Therapy Language
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0%
1%
2%
3%
4%
5%
6%
7%
8%
9%
10%
PR
EV
AL
EN
CE
Admission Diagnosis
Control Group 30-Day Readmission
<0.0001 <0.0001
* p-value
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0%
10%
20%
30%
40%
50%
60%
0 1 2 3 4+
PR
EV
AL
EN
CE
Chronic Condition Indicator
Control Group 30-Day Readmission
* p-value
<0.0001 0.3517 <0.0001 <0.0001 <0.0001
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0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
Readmitted within 30 days Inpatient Admit in last 6 months
PR
EV
AL
EN
CE
Readmission History
Control Group 30-Day Readmission
* p-value
<0.0001 <0.0001
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0%
10%
20%
30%
40%
50%
60%
70%
80%
ICN/PICU Admission Significantpsychosocial concern
Medical transport fromoutside facility
No admission acuityidentified
PR
EV
AL
EN
CE
Admission Acuity
Control Group 30-Day Readmission
* p-value
<0.0001 0.1118 0.1971 <0.0001
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0%
10%
20%
30%
40%
50%
60%
70%
Self Pay Medicaid Commercial/Private
PR
EV
AL
EN
CE
Insurance Type
Control Group 30-Day Readmission
* p-value
0.4303 <0.0001 <0.0001
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0%
2%
4%
6%
8%
10%
12%
14%
1 2 3 4+
PR
EV
AL
EN
CE
Medical Equipment Count
Control Group 30-Day Readmission
* p-value
0.163 <0.0001 <0.0001 <0.0001
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0%
1%
2%
3%
4%
5%
6%
7%
8%
9%
Private Duty Nursing Skilled Nursing
PR
EV
AL
EN
CE
Home Nursing
Control Group 30-Day Readmission
* p-value
<0.0001 <0.0001
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0%
1%
2%
3%
4%
5%
6%
Home Occupational Therapy Home Physical Therapy Home Speech Therapy
PR
EV
AL
EN
CE
Home Therapy
Control Group 30-Day Readmission
* p-value
<0.0001 <0.0001 <0.0001
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Caregiver Language
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Associate Scores
1Admitting Diagnosis
3Chronic Condition
Indicator
2Readmission
History
1Admission Acuity
1Insurance
4DME
1Home Nursing
1Home Therapy
0Language
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Identify High Risk Score
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Identify Risk Score Cut PointsRisk score 14: Excluded from analysis due to only
having 4 out of 5371 samples
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Cross Validate Findings
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C-Statistic Score compared to
Adult Risk Tools
HARRPS
0.68
Modified
LACE
0.63
Cerner’s
Adult
readmission
calculation
0.69
Pra Risk
Tool
0.65
HOSPTIAL
Score
0.76
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Timeline
Investigation of current risk tools
Literature Reviews & Initial Build
Quality Improvement Project
Research Project
Data Review and Tool Finalization
Tool Dissemination
Fall
2015
Spring
2016
Fall
2016
May 2017-
June 2018
Summer
2018
2019 &
Beyond
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Future Implications
What innovative opportunities do we have at Children's Mercy, and through SPS to utilize HARRPS Tool
readmission risk findings?
Questions? Please contact [email protected]