Strategies and Innovations in the CJR Model: Advanced ......Strategies and Innovations in the CJR...

Comprehensive Care for Joint Replacement Model

Strategies and Innovations in the CJR Model: Advanced Discharge Planning and Coordination


February 21, 2019

Audio available through device speakers OR by dialing (800) 832 - 0736

Conference Room:*2657582# Access Code: 022119#

Comprehensive Care for Joint Replacement Model 2

Welcome

Laura Maynard, M.Div. CJR Learning System Team

The Lewin Group

Lauren Nir, MPH CJR Learning System Team

The Lewin Group


Webinar Agenda

• Welcome & Meeting Logistics

• Presentations

– Hackensack University Medical Center

– Seton Medical Center Harker Heights

• Reactions, Questions, & Discussion

• Leaving in Action

• Announcements & Reminders


Meeting Logistics

• All telephone lines are muted• We encourage comments, questions, and

reactions via Chat throughout the webinar• Participate!

– Chat– Poll– Post-Event Survey


Introduction to Adobe Connect

Download Available Resources

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Let’s Chat!

• Use the Chat pod to submit any questions or comments

• Please use “@” if your question/comment is directed to a specific presenter

• Submit your question/comment by clicking the chat bubble icon

• Please share in Chat now : – Organization – Location – A CJR improvement activity currently

in progress at your organization


Presentations

The Center for Medicare & Medicaid Services (CMS), it's employees, agents and staff assume no responsibility for any errors or omissions in the content of this webinar. CMS makes no guarantees of completeness, accuracy or reliability for any data contained or not contained herein. CMS shall not be held liable for any use of the information described and/or contained herein and assumes no responsibility for anyone's use of the information. CMS does not endorse any strategies, tactics, or vendors referred to in this webinar. The views and opinions expressed in this webinar are those of the participants and do not represent the official policy or position of CMS.

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Hackensack University Medical Center

Randy Thomas, BSN , RN, Manager , Orthopedic Special

Projects

Strategies and Innovations in the CJR Model: Advanced Discharge Planning and Coordination

Hackensack Meridian Health

Hackensack University Medical Center

Who We AreHackensack University Medical Center

(HUMC)

US News & Becker’s 775

Beds

Level II Trauma

~2,200 TJA / Year Advanced DSC ‘17

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Care Transition: Planning for dischargeGoal: Default plan: d/c home (done)

*Standardized d/c education!

GAIN:

• Standardization of protocols andcommunications

• Patient satisfaction• Staff satisfaction• Improved patient throughput

CHALLENGE:Synchronizing all touch points

- Adherence to discharge time - Nursing & therapy coordination - Mobilizing patients to location - Patient transport availability - Food & nutrition - Environmental

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Planning for a Pilot• Inter - disciplinary steering

group

• Location

• Patient furniture

• Desk / computer / screen

• Storage & content list

• Patient handouts?

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Team Approach and Accountability

Process Lead: APN

Ortho- Developed a protocol- Convened meetings

Nursing- Survey of current state- Educational materials

Rehab- Film PT / OT review

Support- Patient transportation- Food and nutrition- Env services

Patient & Coach - Standardized

materials - Incentivize

participation - Timely “planned”

d/c

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There’s no place like home J

§ Discharge Instructions§ Pain management§ Getting back on your feet§ In home therapy§ Out patient therapy§ Self directed “therapy”

§ Wound care§ Post discharge call

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Best nutrition for healing

§ Fruits & veggies

§ Drink plenty of water

§ Protein for tissue healing

§ Increases your stamina

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Executing the PlanCommenced Pilot – Oct ‘18

• Patient selection

• Scheduling and facilitating theinstructors

• Coordinating with the floorand then the PACU

• Adding the finishing touchesand refining

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Initial ResultsImprovements & Benefits Across the Board

• Improved satisfaction for:• Patients• Nursing

• Increased standardization and achievement ofHRO aims

• Enhanced throughput and coordination withPACU and floor

Reduce Median DischargeTime

Baseline – 14:00

Pilot – 11:45

Upstream Impacts:

• Reduce OR hold time• If adopted more globally

– increase OR availability

Downstream Impacts:

• Increase rate of PT PODzero

• Reduce burden onnursing at shift change

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Thank you!

Questions?

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Questions & Discussion

• Use the Chat pod to submit any questions

• Please use “@” if your question is directed to a specific presenter


Poll

Blue Button 2.0 is a developer - friendly, standards - based API that enables Medicare beneficiaries to connect their claims data to the applications, services and research programs they trust. To learn more about Blue Button 2.0, click on the following link: https://bluebutton.cms.gov/

Are you using Blue Button 2.0 for your Medicare beneficiaries? • Yes, my organization uses Blue Button 2.0 for our Medicare beneficiaries• No, my organization does not use Blue Button 2.0 for our Medicare

beneficiaries

• I am not sure if my organization uses Blue Button 2.0 for our Medicarebeneficiaries

.

https://bluebutton.cms.gov/

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Seton Medical Center Harker Heights

Stacy Sepeda, MSN, RN, WCC Clinical Programs Manager

Active Again Total Joint ProgramSeton Medical Center Harker Heights

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Seton Medical Center Harker Heights

´ Opened in the Spring of 2012.

´ Licensed for 83 beds small

´ Located in Central Texas near Fort Hood, TX

´ Designations/Certifications: ´ Level IV trauma center

´ Primary Stroke Center

´ Advanced Total Hip/Knee Replacement Certification

´ Chest Pain accredited

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Capacity

Medical Surgical – 55 beds ICU – 10 beds Women’s Services – 8 LDRPs, 10 overflow

beds & 1 Cesarean Section Suite ED – 17 beds, + 4 Overflow Beds Surgical Services – 4 OR Suites, 2 Endo Suites Cardiac Catheterization - 2 suites

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Increasing Communication (1)´ All Active Again Total Joint patients receive a follow up call

every week for the first four weeks after discharge.

´ During these calls we discuss:

´The patients pain and how well it is being controlled.

´Mobility

´Their incision and dressing.

´Answer any questions or concerns the patient may have.

´ In March 2018, we began to notice a gap in communication between the joint team at the hospital, the patient and the home health companies during the discharge follow up calls.

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Increasing Communication (2)

´ The concerns we were hearing frequently from patients were:

´What is going to happen after I discharge from Home health?

´What is outpatient physical therapy? Why do I need it?

´Who will set up going to set up my outpatient physical therapy?

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Increasing Communication (3)

´ Based on the feedback we were hearing from the patients we met as total joint committee to discuss how we could improve this process for all involved.

´We arranged a meeting with all of the Home health companies and discussed with them the feedback and concerns we were hearing from the patients.

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Increasing Communication (4)´ After meeting with all of the Home health

companies we developed a patient progress chart and distributed it to all of the home health companies.

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Total Joint Patient Progress Form

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Patient Progress Forms´ Every week the Physical Therapist sends the form

back to myself and I forward it onto the physician giving them insight into how their patient is progressing in between post operative visits.

´ Utilizing the patient progress forms have allowed us to start planning and having conversations with the patients regarding outpatient PT sooner.

´ Allowing us time to obtain necessary authorizations or work through potential barriers prior to the patient discharging from Home health reducing the possibility of their being a gap in therapy.

Thank you

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Questions & Discussion

• Use the Chat pod to submit any questions

• Please use “@” if your question is directedto a specific presenter


Leaving in Action

• Please type into the Chat pod:– What new information have you identified today that you

will continue to think about and work on throughout thenext month?

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Announcements & Reminders


Continue Discussion on CJR Connect

• Join the Discussion!o Engage with your peers on CJR Connect by liking and commenting on their

posts• If you would like to ask a question of your peers or today’s speakers, you can:

o Go to the Groups tab, select “CJR All” and post your question in the group,OR

o Go to the Chatter tab, type a message into the open text box using the“Post to All” feature.


Upcoming Events

Peer - Led Care Navigation Affinity Group Kickoff Session

March 5, 2019 1:00 – 2:00 PM EST

If you have any questions about this event, send an email to [email protected].

mailto:[email protected]


Reminders

• Send any questions to [email protected].

• To request a CJR Connect account, go to:https://app.innovation.cms.gov/CJRConnect/CommunityLoginand click “New User? Click Here.”

• Please take a few minutes to respond to the Post - Event Survey!

mailto:[email protected]://app.innovation.cms.gov/CJRConnect/CommunityLogin

Strategies and Innovations in the CJR Model: Advanced Discharge Planning and CoordinationWelcomeWebinar AgendaMeeting LogisticsIntroduction to Adobe ConnectLet’s Chat!PresentationsHackensack University Medical CenterStrategies and Innovations in the CJR Model: Advanced Discharge Planning and CoordinationWho We AreCare Transition: Planning for dischargePlanning for a PilotTeam Approach and AccountabilityThere’s no place like home Best nutrition for healingExecuting the PlanInitial ResultsQuestions DiscussionPollSeton Medical Center Harker HeightsActive Again Total Joint ProgramSeton Medical Center Harker HeightsCapacityBackgroundPatient VolumeLength of Stay Total Knee ArthroplastyLength of Stay Total Hip ArthroplastyIncreasing Communication (1)Increasing Communication (2)Increasing Communication (3)Increasing Communication (4)Total Joint Patient Progress FormPatient Progress FormsQuestions DiscussionLeaving in ActionAnnouncements RemindersContinue Discussion on CJR ConnectUpcoming EventsReminders

Strategies and Innovations in the CJR Model: Advanced ......Strategies and Innovations in the CJR...

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Transcript of Strategies and Innovations in the CJR Model: Advanced ......Strategies and Innovations in the CJR...