Soon, hospitals with unnecessary 30-day readmissions will be penalized. Some proactive hospitals are already tackling care transitions to reduce readmissions, improve patient care, and reduce costs.
Lodi Memorial Hospital in Northern California is one such hospital. The 214-bed facility has made preventing readmissions a key strategic goal for improving care, especially for vulnerable, frail elderly patients.
Lodi executives say readmissions are a challenge at the hospital because many different specialties and house staff are involved in the discharge process.
With many options from which to choose, Lodi selected SHM’s Project BOOST (Better Outcomes for Older Adults through Safe Transitions). Project BOOST, unlike other programs, focuses on first identifying system deficiencies, then building cohesive multidisciplinary teams.
“If you layer a clinical intervention onto a broken system,” says BOOST mentor Stephanie Rennke, MD, “success isn’t likely. Project BOOST helps the team map current processes, find deficiencies, assess resources, and redefine a culture of safety.
“BOOST starts with an assessment of how the system functions, and identifies its strengths and weaknesses so you can focus your efforts on critical areas for improvement and tailor the BOOST intervention to fit the unique dynamics of an institution,” she says.
Search for a Solution
No two institutions are exactly the same, especially when analyzing patient-safety culture. Project BOOST is customized to the needs of each BOOST site, which has proven useful to Lodi, as it found it had different needs than other hospitals.
“We chose Project BOOST because it seemed workable and implementable, while offering a less expensive and less complicated solution than competitors’ products,” says Valerie Cronin, Lodi’s director of utilization.
The BOOST mentor, key to this customization, provided Lodi with the reassurance that comes with working directly with someone who has faced similar challenges—not just theoretically, but also on the floor—and was willing to work with Lodi to develop practical solutions. The mentor provided reassurance, support, and perspective as Lodi walked through the BOOST implementation process.
Keys to Success
—Valerie Cronin, director of utilization, Lodi Memorial Hospital, California
Team-focused care, clear communication, and administrative support were keys to successful BOOST implementation at Lodi, says Cronin.
The house staff was overwhelmed, and adding a quality-improvement (QI) project to implement and manage might have seemed like an impossible challenge. By developing multidisciplinary teams, however, Lodi was able to distribute the tasks of implementation and began to recognize the value and benefit of Project BOOST, which already had strong support from hospital executives.
A 14-member multidisciplinary team was formed to oversee the Project BOOST implementation. The team then was divided into sub-groups to work on the main components of Project BOOST: Passport to Care Form, Target Assessment Tool, the Teachback process, and Follow-Up Phone Calls. The sub-groups’ main objectives were to ensure that BOOST effectively changed processes and work practices for a stronger and safer discharge process.
To support these teams and foster communication laterally among healthcare providers and vertically with hospital administration, Lodi established a structured meeting format, delegated task assignments for accountability, and appointed an implementation champion.
Capitalizing on the experience of its BOOST mentor, the Lodi multidisciplinary teams mapped out the process to assess threats to the system and opportunities for improvement, and began moving forward with implementable solutions for sustainable change.
“Evaluating the whole discharge process allowed us to see the gaps and discrepancies in the discharge process,” Cronin says. “Each discipline had their own set of procedures and materials, which proved lacking and inconsistent for our patients. It was an essential and eye-opening experience for Lodi to make change.”
One of the biggest revelations was learning how broken the discharge process was for the nurses. When Lodi looked at its current process of using case managers to handle high-risk patients and leaving the remaining patient discharges to the nurses, they found that the process was not strong enough to support patient load.
Knowledge Is Power
Cronin says Lodi has standardized its patient educational materials and started the patient education process as soon as patients are admitted. This step optimizes a patient’s understanding of diagnoses and care instructions when the time comes for discharge.
Through the Project BOOST assessment, Lodi ascertained that many of its patients were being discharged to skilled-nursing facilities, which heightens the complexity of post-care and introduces the potential for increased risks. Lodi is now working to better communicate with the skilled-nursing facilities using its Project BOOST training to streamline the discharge process.
The implementation of the Teach Back communication strategy has been critical in increasing patient knowledge and adherence to care instructions, official say. Based on the success of Project BOOST implementation, Teach Back has been incorporated into mandatory nurse training throughout the hospital.
More than 80 patients were discharged through the BOOST process in the first 90 days of implementation. Lodi is already experiencing the benefits of Project BOOST organizationally and
expects to see the financial impacts soon through a lower 30-day readmission rate.
“Lodi has experienced a shift in patient safety culture with improved communication through a team approach to care,” Cronin says. “Lodi expects high success through Project BOOST with the goal of implementing Project BOOST across all disease states and every discipline using Teachback.
“Project BOOST has been the ideal program to align with our strategic organizational goals to improve transitions of care and re-create the patient safety culture to make systemwide sustainable change,” she says.
For more information about Project BOOST, visit www.hospitalmedicine.org/boost.
Jacqui Petock, marketing project manager