Vila Health™ Data Analysis Introduction Email from Sienna Pope Hospice Adverse Event

Vila Health™
Data Analysis
Introduction
Email from Sienna Pope
Hospice Adverse Event Data 2014-2015
Interviews with Stakeholders
Email Response to Sienna Pope
Conclusion
Introduction
Quality improvement initiatives are a critical tool in the ongoing effort to improve patient care at health care organizations. But without data, many QI initiatives would fail — or the problem behind them might never be detected. That’s why data, and the dashboards that present data in a comprehensible fashion, are essential for QI efforts to succeed.
In this activity, you will assume the role of a quality assurance analyst at St. Anthony Medical Center. You will be offered both a dataset that you can use to outline a quality improvement initiative, and input from stakeholders who can help you contextualize the data.
Educational Goals
After completing the activity, you will be prepared to:
Analyze data to identify a health care issue or area of concern.
Outline a QI initiative proposal based on a selected health issue and supporting data analysis.
Integrate interprofessional perspectives to lead quality improvements in patient safety, cost effectiveness, and work–life quality.
Email from Sienna Pope
QI Data For You
From: Sienna Pope, Director of Medical Support Services
To: Kaie Manor
Kaie,
Hi! I heard through word of mouth that you were looking for some possible areas of improvement in the hospital. I’ve got some data from SAMC’s in-home hospice program that might be useful.
I realize that you may not be familiar with the hospice program, so I also set up some meetings with a few people with a stake in the program. I’m hoping they can give you some context for the data you’re looking at.
Let me know if you need anything!
Sienna Pope,Director of Medical Support Services
Hospice Adverse Event Data 2014-2015
Per Vila Health policy, these figures include near misses as well as events that resulted in some level of harm or potential harm to the patient. This is a summary of the data; a downloadable spreadsheet that provides all the data you will need for your presentation is also available below.
Unit – Year
LOS Less than 7 Days
IPU Admission
Pain Level 7-10 More than 24 Hours
Inadequate Symptom Relief More than 24 Hours
Hospice 2014
50
47
13
13
Hospice 2015
46
27
17
22
Download XLS
Monthly Adverse Event Reporting – Hospice Unit
Per Vila Health policy, these figures include near misses as well as events that resulted in some level of harm or potential harm to the patient.
Hospice Adverse Event Data (2014)
January
February
March
April
May
June
July
August
September
October
November
December
Total
LOS less than 7 days
5
3
11
0
2
9
0
5
2
0
4
9
50
IPU admission
5
6
7
2
1
4
3
9
3
2
1
4
47
Pain level 7-10 more than 24 hours
0
2
1
3
0
1
1
0
0
2
1
2
13
Inadequate symptom relief more than 24 hours
0
1
1
0
2
0
2
1
2
1
2
1
13
123
Hospice Adverse Event Data (2015)
January
February
March
April
May
June
July
August
September
October
November
December
Total
LOS less than 7 days
10
2
5
6
2
9
8
1
0
0
2
1
46
IPU admission
1
0
1
2
3
2
5
6
1
0
4
2
27
Pain level 7-10 more than 24 hours
2
1
0
0
1
2
3
4
2
1
0
1
17
Inadequate symptom relief more than 24 hours
1
2
1
0
0
2
4
3
6
2
1
0
22
112
Interviews with Stakeholders
Here is a list of stakeholders that you had the opportunity to interview.
Roger GoldenbergDirector of Hospice Services
Jackie SandovalChief Nursing Officer
David BrooksQuality Assurance Director
Owen WelchCFO
Owen WelchCFO
What is the current state of the hospice program’s physical plant?
Well, the current technology — secure laptops with remote access to the EHR — is working, although I think there’s always something better out there. We’re thinking about experimenting with video conferencing to improve care on site; for example, when a physician isn’t available but another is available by video link, that’s an opportunity to improve care. I’ve heard of technology that pushes electronic alerts to hospice nurses so that they can coach caregivers to deliver better care. But of course, we can’t have everything.
Do you feel that the hospice program is resourced adequately?
Well, of course, as with any offsite program like this, you start to have staff issues when staff are stretched too thin. So are they having to spend too much time traveling to patient’s homes, or feeling that their patient census is too high to give each patient the care they really need? I like to think that we’ve balanced care loads among our hospice nurses pretty well. But we can’t know if we’re wrong — absent adverse events, which we really don’t want — unless our nurses tell us.
Roger GoldenbergDirector of Hospice Services
What are the overall goals of the hospice program?
Well, given the unique mission of hospice, we take a different tack from other practices. Since we’re providing end-of-life care, our goal is comfort care, not urgent or life-saving care. That means we treat the symptoms, not the disease. Unlike other units, the patient is a recipient of care, but so is the family.
What is your approach to meeting those goals?
We use a holistic approach, in that we try to address not just physical, but also emotional, psychological, and spiritual needs. With each patient, there’s an interdisciplinary team that delivers care at home. When symptoms arise that need more aggressive management than home care can provide, we do temporary inpatient admissions.
Jackie SandovalChief Nursing Officer
Roger Goldenberg mentioned that an interdisciplinary team is an important part of the hospice approach. Who do you consider to be part of that team?
Many different roles, actually. Of course the nurse, a hospice physician, and a social worker are going to be involved. Often home health aides are part of the team, as well as the volunteer coordinator and the chaplain. Depending on the patient and their circumstances, sometimes music, art, or physical therapists are also engaged in the patient’s care.
What would you consider to be quality-related “red flags” as far as the data categories?
One big problem we see in hospice is that patients are referred too late — that is, too close to their end of life. So they aren’t able to receive all of the benefits of being in the hospice program. So length of stay is something you’ll want to look at. Then, of course, the effectiveness of pain and symptom management.
How do hospice nurses document and communicate data between their on-site location and the rest of the team?
All of our hospice nurses carry laptops so they can live-chart patient-related data, just like inpatient nurses on site use connected devices to update the EHR. In some homes, where wi-fi isn’t available, those nurses just take notes on their laptops on site and then chart later.
David BrooksQuality Assurance Director
What are the processes that the hospice program uses to ensure safety?
We’ve got processes and procedures in place for managing movement for patients who are at risk of falls, for maintaining sanitary conditions, for managing medical waste (for example, if a patient has a catheter in place), and for safe storage of pain and other medications. And we have processes for pain assessment, which are also part of our protocol for assessing the need for an IPU admission.
What about quality?
That’s somewhat reflected in our adverse event reporting. Obviously, we’re not delivering quality care if all we do is prevent adverse events. But our processes are geared to prevent those events and make sure we’re helping the patient to face the end of life as comfortably as possible. So our nurses monitor pain levels, symptom levels, and the patient’s overall level of comfort, as well as that of the family and caregivers. They ask a lot of specific and general questions to get at the patient’s quality of life, from their own perspective and from that of their loved ones.
Email Response to Sienna Pope
QI Data For You
From: Sienna Pope, Director of Medical Support Services
To: KM
I hope you got what you needed from Jackie, David, Roger, and Owen. Can you send me an email and let me know what your initial thoughts are? It doesn’t have to be anything formal, just your ideas about what the data suggest, and whether there are any QI initiatives that you would recommend based on what you’re seeing. If there are, make sure you explain how the initiatives you recommend might affect the different roles on the hospice team.
Thanks!— Sienna
Your reply to Sienna’s email should summarize what you’ve learned during this activity. It might also be helpful to articulate any questions or research you plan to do. The reply will be available in your activity log and can be used as a pre-writing activity for the unit assignment.
Email you sent
Thank you for your email. I’m still trying to gather my thoughts and ideas so I will get back to you.( I didn’t write in this email because as the writer I know you will have your own perception so that you can write the paper. I just typed in this so that I can download the activity for you)
Conclusion
Having met with some stakeholders, you should now have a solid understanding of what the data you gathered is telling you. You should be able to use this information to complete your assignment in the course.