Last year Oschner Health System treated patients from all 50 states and became a preferred destination for healthcare between Birmingham and Houston.
In a session titled "Ensuring Access for the Next Patient Through Improved Communication," at the Becker's Hospital Review 6th Annual Conference, three executives from Oschner Health System discussed how the system moves patients through safely and attracts new patients every year. Oschner Medical Center-New Orleans CFO Henry Reese Jr.; Chief Nursing Officer of Oschner Medical Center-New Orleans Trudi Stafford, RN, PhD; and COO, Oschner Medical Center-New Orleans John Herman gave the presentation.
The hospital has made several changes over the past few years to optimize patient experience and provide better care. This meant bringing together case managers on the front and back end to follow patients and make sure they had the full continuum of care.
"We went to patients in the markets where we don't have much influence and we made sure they didn't get lost in the shuffle," said Mr. Reese. "We also reduced the length-of-stay and had fewer patients who were in the outlier bucket for staying to long. Finally, we created 992 virtual beds, allowing us to get more patients out the door."
Another tactic they implemented was multidisciplinary huddles lasting around 15 minute where the different units came together and discussed care with one another. The huddles included medsurg, critical care, physicians and front line nurses as well as the pharmacy staff, clinical therapy and occupational therapy.
At every huddle, the essential discussion points were:
• Expected discharge dates for patients
• Medical milestones
• Discharge needs and barriers
• Patient and facility communication
"Commit to the discharge day and talk about it with everything you do with the patient," said Ms. Stafford. "That date can change if necessary. We also discuss medical milestones at every huddle, and many service lines have pathways for patients to go through before they hit the next level of care. We are trying to establish those levels going forward."
The key questions to ask about the patient in the huddle are:
• Where did the patient come from?
• What is the initial plan for returning home?
• Where else might the patient go after discharge?
• What is the patient doing here?
• Is the diagnosis or procedure elective?
• Is the patient high-risk?
• Can the patient be discharged today?
• If the patient can't be discharged today, why not?
"Figure out the patient's requirements and where they will go after discharge," said Ms. Stafford. "Figure out the needs of the patient and family to develop the earliest expected discharge. Moving the patient to the next level of care, especially when patients are in the critical care area, the patient and family becomes anxious about the transition. Address concerns as many times as possible. Sometimes we need an alternative plan as well. Sometimes the families want the patient to go to one place, and sometimes that's not possible."
The health system has a centralized patient placement model to manage capacity and accelerate bed utilization. They leverage house supervisors to manage bed capacity and established a capacity alert plan. After initializing the plan, it took four to six months to put it in place, the numbers came back great. But then in a more recent report the numbers weren't great.
"We took a substantial step back," said Mr. Herman. "We questioned ourselves. We started the initiative from an authoritative order, and it was our primary focus for four to five months, but we needed to change our approach. We had teams connected to the right tools and we knew they weren't driven by dollars, but we had to get their hearts in it. Everyone's heart is a little bit different, but in our heart we had to keep the patient."
Mr. Herman and the health system leadership talked to staff members and asked them to think about patients as their own family members; they'd want their family members to have efficient and effective care. They also talk about what happened in the past week; sometimes there are 15 to 20 more patients over the prior week, so it seems like the staff is doing more, but really the length-of-stay for each patient is shorter so the capacity is the same.
"That's what motivates them to continue our work," said Mr. Herman. We talked about the total length-of-stay, the normal patients and the outliers and we treat every individual patient as individuals. We talk about variance and recognize work that different departments are doing to see significant improvement."
The team continues to work on:
1. Consistency to make sure their four-week trend of better numbers is flat or improves.
2. Identify placement issues and focus on data to avoid lost days.
3. Continue conversations in the huddle for care plans.
The hospital has saved around 2,000 days and has had a financial return of about $2 million this year.