Can reducing surgical readmissions be as simple as brushing your teeth?
Today we are targeting the surgical patient population for a simple readmissions intervention: tooth brushing.
Improving oral hygiene prior to surgery is an emerging recommendation to reduce the risk of post-operative infections. Problems with teeth or gums can be a major source of bacteria that can enter the bloodstream or lungs causing pneumonia or sepsis, both of which are leading diagnoses related to readmissions.
There is evidence that patients undergoing cardiovascular surgery and major cancer surgery benefit from preoperative oral care. However, a clean mouth prior to surgery is good for all patients. Do your patients know they can brush their teeth the morning of surgery, even though they may be NPO?
Postoperatively, good oral hygiene continues to protect patients from pneumonia, yet studies show that 70% of hospitalized patients do not receive adequate oral hygiene. For more information about improving oral care for patients, read this guide about the problem and a solution utilizing a nurse-led hospital-acquired pneumonia program that proved that oral care is much more than a comfort measure.
Just for fun: Want a tool to engage pre-operative patients in upping their brushing game? Brush DJ is a fun app that uses music and buzzes every 30 seconds to change sides and a round of applause when you finish after 2 minutes of brushing.
If your organization is ready to get serious about reducing readmissions, review the Cynosure Readmissions Discovery Tool to see where there are opportunities for improvement beyond oral health in your organization.
Reduce Readmissions by Involving Pharmacists in your Medication Reconciliation Process
Did you know, an easy way to reduce readmissions is by getting pharmacists involved in the medication reconciliation process?
Studies have demonstrated that up to 20% of readmissions are due to medication-related problems (MRPs) and that 70% of these problems are preventable if pharmacy staff are part of the discharge process.
In fact, Duke University Hospital published results of a pharmacist-led discharge medication reconciliation process with the aim of reducing discharge medication discrepancies and unplanned readmissions. 67% of the patients needed an intervention that was discovered by the pharmacist, even though the provider already completed a preliminary med rec.
So, should your organization start?
4 Steps to Reduce Readmissions through Medication Reconciliation
- Review the discharge medication reconciliation process using the Med Rec Discovery Tool.
- Ask several clinicians who are currently responsible for discharge med rec to describe the process and compare the discovery tool. Chances are that if nursing staff or providers are carrying out this task independently, there is room for improvement.
- Engage your pharmacy staff to identify strategies to implement in closing gaps discovered through your review.
- Test! Select one pharmacy-driven strategy to test. Start small with a segmented group of patients. Use your data to determine which small group of patients to prioritize for the first tests of change. This small group of patients in the initial test of change might be identified by age, diagnosis, number of medications, drug classifications, or patients on two or more drugs of the same class for review to keep the pharmacist discharge med rec manageable.
We always recommend testing small groups, reviewing the results, noticing any improvements or learning opportunities, and continuing until you find the best solution to serve your patients. Even 1 avoided readmission is making strides toward a safer patient population because of your efforts.
Importance of Self-Assessment to Identify Gaps in Sepsis Protocols
We sat down with Cynosure Health Improvement Advisor, Maryanne Whitney, to get her take on the self-assessment of sepsis protocols and advice she has for hospitals who are looking to improve. Let’s dive in.
How does self-assessment improve sepsis mortality?
A self-assessment can highlight strengths and identify gaps or areas that may be an improvement opportunity. These improvement opportunities can lead to lives saved through earlier detection methods or improved intervention strategies.
What information will garner the most buy-in for change?
Data will often garner buy-in. Self-assessments and discovery tools are "real" data of an individual facility's sepsis programs and can serve as a "reality check." During the self-assessment, we look at what we know needs to be happening for patients with sepsis vs. what is actually happening. This realization in an organization can be a very powerful motivator for change.
How can physicians or leadership be more involved?
Leaders need to be involved as sponsors of a sepsis program, ensure that sepsis mortality reduction is a strategic goal, and mitigate barriers for the teams. Physicians are critical members and leaders in a sepsis program. Without a physician champion for sepsis, change and improvement in sepsis protocols is difficult.
If you’re ready to review your sepsis protocols and make a plan for improvement with a self-assessment, assess your current practices using the Cynosure Sepsis Discovery Tool.
Together we can improve health care further, faster.
Reducing Readmissions for Patients with Sepsis
Each year, more than 19 million individuals develop sepsis, defined as a life-threatening acute organ dysfunction secondary to infection. Approximately 14 million survive to hospital discharge, and their prognosis varies.
Of the survivors, 50% fully recover, 1/3 die within one year of discharge, and about 1/6 have ongoing impairments.
These impairments include functional/mobility issues, mental health issues, and exacerbation or rapid decline in chronic conditions. This puts patients who have experienced sepsis at increased risk for hospital readmission.
Despite the challenges facing patients following hospitalization with sepsis, guidance for healthcare professionals for providing optimal post-hospital sepsis care is not well established.
This article released in JAMA examined ways to enhance recovery after sepsis. The article suggests that post-hospital sepsis care should focus on:
- Identification of new physical, mental, and cognitive problems and referrals for appropriate treatment.
- Review and adjustment of long-term medications.
- Evaluation for treatable conditions that commonly result in hospitalization, such as infection, heart failure, renal failure, and aspiration.
- Consideration of palliative care for patients with poor or declining health prior to sepsis who experience further deterioration after sepsis.
If you’re looking to improve your sepsis protocols and reduce your readmissions, review the Cynosure Sepsis Discovery Tool and the Cynosure Readmissions Discovery Tool to find areas of opportunity for improvement. Because together we can improve health care further, faster.
Why Improve Sepsis Protocols and Detection Methods
Written in collaboration by Sepsis Alliance and Cynosure
The question of why might be something you hear throughout your organization. Maybe what follows is that sepsis protocols are “good enough” or that there isn’t bandwidth to improve.
The truth of the matter is, sepsis continues to be a public health crisis that needs our attention. In fact, more than 1.7 million people in the U.S. are diagnosed with sepsis each year. In the United States, sepsis takes a life every two minutes - this is more than opioid overdoses, breast cancer, and prostate cancer combined.
If those facts aren’t enough, sepsis is the number one cause of hospital readmissions, costing more than $3.5 billion each year.
As Sepsis Awareness Month begins, we ask that you to take another look at your sepsis protocols and detection methods. We encourage you to see if there are any obvious areas for improvement. Improving our sepsis protocols and detection methods can (and will) save lives.
More about Sepsis Alliance
Sepsis Alliance is the leading sepsis organization in the U.S., working in all 50 states to save lives and reduce suffering from sepsis. The organization was founded in 2007 by Dr. Carl Flatley, whose daughter Erin died unnecessarily of sepsis when she was 23 years old. Sepsis awareness can and does save lives, yet only 63% of American adults have ever heard the word sepsis.
The Sepsis Alliance team works to produce information for both healthcare professionals and the public to elevate sepsis care with education, resources, and networking.
We encourage you to register for an upcoming educational event - the Sepsis Alliance Summit! Join Sepsis Alliance for a FREE, virtual conference on sepsis held on September 27 and 28, 2023. Sepsis Alliance Summit features two days of virtual expert-led sepsis content and opportunities to engage with other healthcare professionals. Free continuing nursing education credits will also be available!
Where to Start to Improve your Sepsis Protocols and Detection Methods
Sepsis Awareness Month is a great time to begin to examine your current efforts and gain ideas and inspiration for further improvements. As you begin to take further action to improve awareness of sepsis mortality and morbidity, a great first step is to assess your current practices using the Cynosure Sepsis Discovery Tool to provide a real time evaluation of your current processes and by reviewing the 2023 Cynosure Sepsis Safe Hospital Self-Assessment.
Next, connect with the right information and tools to support your efforts. Sepsis Alliance has released a Sepsis Awareness Month tool kit to help inspire your Sepsis Awareness month activities.
Then, join us as we highlight hospital best practices in our Cynosure Sepsis “How to” Series:
- Sepsis Screening & Implementing an Hour One Bundle will be featured on September 21 @ 1:00 pm EST register here
- Handoff checklists and Post Sepsis Support Groups will be featured on September 28 @ 1:00 pm EST register here
Now is the time to get started! You can learn more about sepsis and find other ways to get involved at sepsis.org.
Emerging Problems in the US Health Care System: 3 Ways to Mitigate Diagnostic Errors in Medicine
Diagnostic harm and diagnostic improvement have become buzzwords in patient safety and risk management and with good reason. A recent study by Johns Hopkins showed that medical providers misdiagnose 11% of the time, but this rate differs widely from 1.5% diagnostic error rate for heart attacks to 62% diagnostic error rate for spinal abscesses. This is cause for considerable problems in the US health care system, especially when it’s already feeling fragile post-pandemic.
The good news is that we in the medical community recognize a problem, and we’re ready to do something about it. So, how do we mitigate diagnostic harm and help reduce diagnostic errors in medicine?
1. Develop Tactics to Identify and Learn from Diagnostic Errors or Near Misses
We have so much data at our fingertips, and we can use this to learn from or identify any diagnostic errors. Here are a few places you can find a diagnostic error or a near miss:
- Use data: Review adverse event reports or any medical malpractice data. Gaining knowledge and learning from the data at hand helps ensure history isn’t repeated.
- Learn from your patients: Review patient complaint logs. They can tell you so much about the patient’s feelings, where a diagnostic error might have happened, and what steps could help in the future.
Now we know where to find them, but what do we do with it? We suggest a regular cadence of review of these data points. Gather a team that will review together and then strategize different ways to mitigate this instance in the future.
2. More Effective Teamwork during Diagnostic Process
A lot of times, more eyes, more ears, more brains, and more experiences coming together can create a better overall diagnosis for a patient. We suggest having a process where multiple health care professionals are involved with a diagnosis, especially a more difficult case or one you’ve rarely seen. No matter how many years of experience you have, there can always be something missed or symptoms you haven’t been presented with before that can cause a misdiagnosis.
A great place to start is working with your Quality Director to create a small test of change in how to gather a diagnostic team.
3. Enhancing Health Care Professional Education and Training Around Diagnostic Process
More training and education is usually a great answer when there’s a problem to tackle. When it comes to something like diagnostic accuracy, a refresher course is a great place to start. Thankfully, ARHQ’s TeamSTEPPS Diagnostic Improvement Course is developed to improve diagnostic accuracy for individuals or large groups. For more information on the course, please go here.
At Cynosure, we have many team members that are certified TeamSTEPPS trainers and know the ins and outs of the TeamSTEPPS Diagnostic Improvement Course. If your organization is wanting to implement this vital training, but isn’t sure how to get started, please reach out to us today.
Care Transitions: Improving Discharge Phone Call Outcomes
When it comes to discharge phone calls, we often encounter the "my patient didn't answer" obstacle. Such a vital piece of the care puzzle shouldn't get bypassed because our team was sent to voicemail. This article outlines a few ways to increase the chances of patients answering this important phone call.
Tactics to Increase Answering of Discharge Phone Call
1) Tell the patient in advance that you will call and share the purpose of the call or details you might discuss
2) Schedule a convenient time for the call
3) Ask if a significant family member or caregiver can be present and make sure the scheduled call works for them
4) Create reminder magnets with the date and phone number you'll be calling from
5) Put a post it note with the date and phone number on the top of the discharge papers
Bonus: Telling the patient and/or caregiver the phone number you'll be calling from ensures they have a callback number in case they miss your call or they need help prior to the follow up
Example: What can I do to Improve Care Transitions in 1 Week?
Let's walk through an example of telling the patient in advance about the discharge phone call, scheduling a day and time for the call, and what number they will receive the call from.
Monday: Review the QI Project Planning Worksheet that will guide you through the steps of planning for a Small Test Of Change (STOC).
Tuesday: Huddle with your hospital team that will be involved in testing something new and explain the expectations.
Wednesday: Test one change idea with one or several discharges that day. Huddle with your team after. How did it go? What would make it easier? What challenges did you encounter? What will you do differently with the next patient, tomorrow?
Thursday: Try the test again with modifications based upon Wednesday’s experience.
Friday: Call the patient or family caregiver that you tested advance notification intervention with. Did they pick up the call? If yes, what made them answer? If no, reflect on your STOC conducted on Wednesday. Will you adapt or abandon the change idea? Will you try adding a post it note with the date, time and phone number you will be calling from?
All this to say, discharge phone calls may be low-hanging fruit to capitalize on that can do a great deal to help decrease your readmissions and continually better serve your patient population. If you’re looking for more ways to improve your Care Transitions, reach out and we’d be happy to talk strategy with you.
For the New Quality Manager in Health Care: Determining Where to Start
Stepping into any new role is scary, but stepping in as a new Quality Manager in health care can be particularly challenging. You may be so familiar with being on the floor or in a clinical setting and dealing with the hustle that brings, that switching to this role may feel completely overwhelming. And that’s okay.
As a quality manager in health care, you’ll take on new acronyms, reports, leadership strategies, improvement planning, and more. Just when you thought you’d made the right career decision, you probably started to second-guess it. Yearning for the familiar is normal and expected, so we assure you that you aren’t alone in this.
Now we aren’t saying this to imply there’s nothing you can do about it. In fact, we have a handy guide to help you navigate those first few months to help ease the transition.
Find Other Leaders in the Organization
Getting to know your new colleagues and their roles in the organization is a huge first step in building the foundation of your new role. As a quality manager in health care, knowing who else will be on your team to build and implement new quality measures can help you identify where to go when you run into any sticking points.
It’s also important not only to build allies but to have a good face-to-face relationship with everyone. With that, you have more leverage – building rapport helps to make for smoother policy changes or testing suggestions.
Identify your Champions of Change
Your Champions of Change aren’t always leadership. These individuals that will actually help implement or test a new procedure are often your most stellar staff member. They must be highly liked and highly respected by their colleagues. If they start to change their routine for the new procedure you’re testing, often their colleagues will follow suit.
You can find your Champions by observing the department. See how team members interact. Take note of who is speaking when everyone else is listening. Find who is already leading. If it’s hard to identify, talk to a few of the staff members or leadership team members to see what their thoughts are. Finding your champions will help make your new policies run a lot smoother.
Small Steps, Big Rewards
Speaking of new policies, when you jump into your new role, you might want to start by making a huge splash and improvement. However, we don’t recommend this approach. Thinking too big actually can backfire sometimes.
We suggest you start small – start in one department, with one team, on one shift with whatever policy you’d like to test. Often we can’t see potential negative outcomes of even the best-intended new policies, and starting small can mitigate any large negative effect.
Know When to Seek Outside Help
Getting outside training doesn’t mean you’re a failure at your job; it means you care about your new role and organization enough to want to succeed. You recognize you may not have all the answers, but you’d like them. Finding a guiding light during this transition time is a huge asset, but not everyone is so lucky to have a colleague who’s been in their shoes.
Thankfully, at Cynosure we’ve recognized this and created an on-demand course designed for new quality managers in health care that have been in their role for 6 months or less. New Quality Director Orientation: What I Wish Someone Had Told Me on my First 30 Days on the Job is taught by Dan Lanari, who has been exactly where you’re sitting before. He felt lost, frustrated, and like a failure at his new job. But he’s broken down everything he wishes he knew, so you don’t have to keep wondering.
If you’re new to your role and ready to get some proper training, you can learn more about the New Quality Director Orientation: What I Wish Someone Had Told Me on my First 30 Days on the Job and sign up for the course here!