1. Preventing Unplanned Readmissions – The Dell Children’s Medical Center Experience
Terry Stanley, DNP, RN, NE-BC
Director of Quality and Operational Effectiveness

2. The Evolution Alignment with Seton Network LEM goals for FY17
PHIS database revealed our biggest opportunity was APR DRG 137 – Major Respiratory Infection/Inflammation (36% readmission rate)
Characteristics of the patients who were readmitted
Chronically ill with multiple healthcare problems
Index diagnosis frequently associated with aspiration
Readmissions usually not related to the index admission; seizures was most common reason for readmission

3. Gaps in structures and processes – the barriers
Patient education resources and Teach Back
Lack of resources to manage transitions for complex care patients
Med rec challenges from admission to discharge
PHIS reports 6 month delay make it difficult to measure impact of interventions

4. Facilitators to improving performance
Post Discharge Call Transition Program
REDCap survey to all parents of readmitted patients
Strong physician engagement
Network priority
Avoidance of monetary penalties from State
Acquisition of Health Intent Data Warehouse & Tableau visualization software along with the right people to leverage these resources; we now have monthly metrics for all APR DRGs in a Dashboard.

5. The journey
Established interdisciplinary team with first meeting in September, 2016; initially met X1/month, now X2/month.
Physicians
Social Work
Care Management
IS/EHR
Nurses
Pharmacists RT
Education

6. The journey
Thorough search & appraisal of readmission literature including SPS Readmission Pioneer work
Deep dive to identify characteristics of APR DRG 137 patients
Examined data from post discharge phone calls and surveys from parents of readmitted patients
What we learned:
No single or cluster of causative factors for our readmissions
Numerous “best practices” to address all cause readmissions
Removing identified barriers would benefit all patients, including APR DRG 137

7. The decision Focused on 3 possible pathways:
Proceed with finding solutions specific to our target population (APR DRG 137)
Proceed with finding solutions specific to complex care patients
Proceed with solutions for all cause readmissions
We decided to focus our initial efforts (2017) on all cause readmissions and then begin to drill down for specific populations such as complex care and others once we have addressed the all cause readmissions in 2018.

8. Next steps
From a list of best practices taken from studies in our lit review and the SPS readmission bundle, we have identified 4 primary interventions/improvement efforts:
Provide discharging physician(s) notice their patient was readmitted
Improve the congruence/accuracy between admission med rec and discharge med/rec (therefore discharge instructions)
Assure discharge instructions contain a plan for parents to address common problems including an escalation plan (e.g. fever, pain, wound issues, etc.)
Implement Teach Back throughout the hospital for all disciplines that provide patient education
Concurrently we are also addressing our chaotic process for developing and maintaining patient education resources, including health literacy principles