1. Scripps Mercy Hospital Chula Vista
Improved Communication Through Multidisciplinary Huddles (MDH) Results in Reduced Patient’s Length of Stay
Current state at Mercy’s
Improvement efforts around process metrics (WDI, Med Comm., Responsiveness). 
Question to team - What are challenges and what they know as next actions. 
Sussie Pangcog, MSN; Sonja McAllister MSN, CNS, CCRN-K; Carly Blair, RDN; Michele Tsugawa Billand, Pharm.D.; Steve Gilbody, MBA, BSN, RN, CCM; Julia M. King, PT, CEES; Kimberly Rodriguez, BSN
March 22, 2019

2. Scripps Mercy Hospital – Chula Vista
183 Licensed Beds
Emergency Department
General Medicine
Specialties
Acute Care Beds
Medical/ Surgical
Oncology
Telemetry/ Step Down
Intensive Care
Maternal Child Health

3. Background
Inpatient length of stay (LOS) nationally averages 5.3 days at a cost of $377.5 billion dollars annually.
In 2017, our community hospital’s LOS was 4.07, below the average however we felt there was still opportunity to improve.
Nurses identified fragmented communication between disciplines as a contributor to LOS.

4. Background Historically, various methods of communication trialed
Care Management Rounds
2016 Patient Care navigators converted to Care Managers, floor based, case load patients
2017
Kardex in each chart
Ingenious Med Bills (IM Bills) at SD only
Bedside huddle for all new admissions (SD)
Centricity EHR
Patient Navigation where a Case Manager (called Patient Care Navigator was rounding with the Hospitalist team avgas pts) throughout the hospital from admission to discharge.  This occurred from   We didn’t do it hospital wide at either SD or CV as this model is extremely costly to have an RN Case Manager assigned to only patients.
In 2016 the Patient Care Navigators were converted to Care Managers and they work 10hr shifts and average case load of 20-25pts per CM, but floor based instead of hospitalist based.
Hospitalists billing program called Ingenious Med Bills (or IM Bills).  It was an electronic platform to handoff to each other between disciplines on the  discharge plan. This was used 2017 only at San Diego.
4th floor at SD, where we had bedside huddles for all new admissions.  Rehab, Case Management (CM & Social Work), Bedside RN, Access rep and MD when available would go in to see the new admits on the 4th floor at SD

5. Exceptional care, for every patient, by every caregiver, every time
NEXT
Exceptional care, for every patient, by every caregiver, every time
December 2017 Model Care is launched at Mercy SD as System Pilot unit
January 2018 Mercy CV 4th floor launched pilot Model Care
Multidisciplinary Huddles an element of Model Care
Model care is
Scripps’ intent to retain its brand as a market and national leader requires we provide an exceptional patient experience, free from error, and at a much lower cost.
The structure of model care
Standard work - reports
Attendance of providers
Schedule of hospitalists
Teaching attends – not early adopters

6. Multidisciplinary Huddle (MDH)
Purpose
To improve the patient’s experience and reduce the duration of a patient’s stay in the hospital by improving communication among disciplines and identifying barriers to their discharge
Outcome
Specific, clear next action (What, Who, and by When) to progress the patient’s care
Shared understanding among care team members about the patients on the unit and their daily needs
Strive for 100% of patients on the unit are reviewed, 7 days a week
What’s the difference between previous efforts – Care Management rounds, Bedside Rounds?

7. MDH Structured Consistent Time, Location, Attendees, Report
Identify & discover barriers to discharge
Communicate with team to address barriers
The team huddles at a visual patient management board which contains patient demographics, hospital progress, team concerns, barriers to discharge and estimated date and destination of discharge for a safe discharge.
Standard work is used to provide key information about the status of the patient’s care, creating a shared understanding about the plan of care including discharge plan.

8. MDH
Standardized daily time – 1000
Prep work
MD Schedule

9. MDH Standard Work

10. MDH Dedicated Board Room number Patient initials
Inpatient or observation
Accomodations – m/s, tele/ sd/ICU
Progress
Concerns
Barriers to DC
DC Plan

11. MDH Report

12. MDH Evolution of Engagement
Major Change for everyone
Cautious engagement by all disciplines
Time consuming
Staff availability
Physician buy-in and schedules

13. MDH Evolution of Engagement
Scripps committed to improving patients’ care
Staff including all disciplines committed to improving communication
Physicians committed to creating schedule that hospitalists would keep
MDH implemented with structure, discipline and accountability

14. MDH Significance
Utilizing MDH, interdisciplinary communication has improved and LOS has decreased.
A Charge Nurse leading the structured MDH has improved the average LOS by 10%. All disciplines involved believe that MDH is a valuable venue for discussion as well as discovery and early mitigation of patient issues.

15. MDH outcome All disciplines finding MDH is “doable”
30 min time commitment met
Early Collaboration
Follow-up more quick for timely discharge
All disciplines involved in creation of plan of care
Proactive and better understanding of patient’s needs

16. MDH Significance

17. MDH Team Comments Charge RN Physician Case Manager/Social Worker
Clinical Nutritionist
Pharmacist
Physical Therapist

18. Next Steps Weekend coverage same as weekdays
Floor based Case Managers and Social Workers
Physical Therapies floor based
All Patients included

19. Acknowledgements Sister-hospital, Mercy SD
Partners in Care – all our disciplines
Physicians, for close collaboration to make it work
Patient Care Managers
SD – for leading the way in

20. References

21. Contact Information
Sussie Pangcog, MSN Sr. Director Patient Care Services Sonja Mc Allister, CNS