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Expanding Patient Safety Beyond Hospital Walls toPrevent Readmissions  By Jacalyn Liebowitz, BSN, MBA, NEA-BC Vice President, Patient Care Continuum Allegiance Health Jackson, Mich.  Readmission Rate Turnaround As the government looks at ways to improve quality and reduce costs, it is considering the use of readmission metrics for quality-based payments. In fact, the Centers for Medicare & Medicaid Services says that three conditions – congestive heart failure, acute myocardial infarction and pneumonia – account for nearly half of all Medicare readmissions. Like other health systems across the country, Allegiance Health is continuously looking for ways to reduce hospital readmissions — especially those that are preventable. In Michigan, where we are based, heart failure (HF) is the No. 1 preventable readmission, with more than 40,000 cases annually. Three years ago, our readmission rates were highest for this patient population. Now, we have the lowest readmission rate for HF in the state. And we've improved patient safety in the process. Safer Care from Home With HF readmissions high, we knew we needed to:  Improve patient transitions from hospital to home Improve care management and patient education Decrease preventable emergency department (ED) visits and hospitalizations Develop a model to facilitate the exchange of information and tasks across care settingsTwo years ago, we implemented McKesson's telehealth solution to help our HF patients safely manage their care from home. The solution collects and transmits disease management information daily, including vital signs, symptoms and behaviors, enabling caregivers to monitor and adjust treatment plans. It helps ensure early intervention to prevent hospitalization. And it provides patients with medication, diet and exercise coaching to help them stay on track. Healthier, Happier Patients The results so far have been dramatic. HF admissions are down 86%, and our patients feel more knowledgeable, secure and satisfied. Now: Patients are safer. Electronically transmitted information is more accurate and helpsensure patients are following protocol. It highlights outliers quickly and enhances the medication reconciliation process. Patients take an active role in their health. Self-care, treatment and medicationcompliance have improved. Patients better understand their disease and follow their care plan with confidence. Care is more convenient. Our clinicians gather data remotely and take action if necessary.For example, if a patient gains a few pounds but can't get in to see the doctor right away, we call the office and request a change in diuretic medication. This makes life easier for patients and physicians. Care is more cost-effective. We manage more patients with existing resources. Ourclinicians focus on the most critical cases, delivering care when appropriate instead of on a fixed schedule. Remote monitoring means we don't have to send out a nurse every time a patient's condition changes. Preventable ED visits and hospitalizations have declined. Each patient's record isupdated daily, so clinicians can address changes in health status and tailor care to address needs as they occur, reducing costly visits to the ED. Hospital throughput has improved. With fewer HF patients coming to the hospital, the EDis less congested and beds are freed. This is especially critical as volume increases due to the H1N1 flu. Someone to Watch Over Me One of the most interesting benefits is the sense of security our patients now feel. We hear this repeatedly. Patients are comforted by the idea that someone is watching over them. If they are unsure about something, or experience a symptom such as shortness of breath, help is at hand. In every survey, a majority of patients say their quality of life has improved. Our telehealth monitoring helps patients stay at home longer before moving to a skilled-care facility. Family members are more comfortable, so they're less likely to trigger a transition to skilled care. Additionally, we find this is an excellent way to use nurses with clinical expertise who no longer have the physical ability to keep up with patient care on the unit. Their experience .and knowledge are invaluable. Previously, our safety initiatives focused on patients in the hospital. Technology has enabled us to broaden safety across care settings into the patient's home. Our HF results have been so successful, we recently expanded use of the telehealth solution to our pneumonia and COPD populations. And last year, Michigan recognized us for the lowest HF readmission rate in the state. Jacalyn Liebowitz has served as Vice President of the Patient Care Continuum at Allegiance Health for the past ten years. In this role, she oversees numerous inpatient and outpatient clinical departments, oncology and chronic-care service lines, hospice, homecare, and a long-term acute-care hospital. She serves as executive champion for patient safety and customer excellence at Allegiance. She has been intimately connected to the care of patients who have chronic disease needs that are managed through telehealth for more than six years. Ms. Liebowitz is board certified as Nursing Executive Advanced from the American Nursing Certification Center.   |
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