1. Implementing “ER is for Emergencies” in Critical Access Hospitals RHQN Best Practices Call June 12, 2012 Facilitator: Bev McCullough, RN, MBA, CPHQ Director, Quality Improvement RHQN

2. Implementing “ER is for Emergencies” in CAHs  Agenda: Overview: Bev McCullough Kittitas Valley Community Hospital-Ellensburg Rhonda Holden, RN, MSN, CNO Director, Patient Care Services Eric Davis, RN ED Director Q&A: Amber Theel, RN, BSN, MBA, CPHQ, CPHRM Director, Patient Safety Practices “ER is for Emergencies” Lead Washington State Hospital Association ambertheel@wsha.org

3. “ER is for Emergencies” As you develop your program: Remember John Kotter’s “Eight Steps for Successful Change”*:  1. Create urgency: (June 15th: That’s a given!)  2. Form a powerful support group: (Who is your ER physician champion and team?)  http://www.kotterinternational.com/kotterprinciples/ChangeSteps/

4. Eight Steps for Successful Change 3. Create a vision for change: Link the seven “ER is for Emergencies” Best Practices to your organization’s values. “A”: Use an Electronic Health Information Exchange “B”: Provide Patient Education “C”: Participate in Patient Review and Coordination (PRC) “D”: Use PRC Client Care Plans “E”: Implement Narcotic Guidelines “F”: Participate in Prescription Monitoring Program (PMP) “G”: Use Feedback Information for improvement

5. Eight Steps for Successful Change  4. Communicate the vision: Talk openly and honestly about the challenges of the change and also how it links to your CAH’s vision. Create a 30 second “Elevator speech”.  5. Remove Obstacles: Visit your clinics and engage the physicians, receptionists and staff.  6. Create Short-term wins: Do a Mock Scenario, a FMEA, and reward people who help make your plan a success

6. Eight Steps for Successful Change  7. Build on your success. Continuously improve. Look for opportunities to partner with your clinics for improved patient care to reduce ER visits: (Example: Clinic receptionists and staff education about the Heart Failure patient “Stoplight Tool”)  8. Anchor the changes in your corporate culture. Celebrate successes at your employee and Board meetings. Tell your success stories often. Include in new hire education.

7. Eric Davis, RN Rhonda Holden, MSN Kittitas Valley Community Hospital June 12,2012

8. Kittitas County 8

9. Who is using EDIE? 9

10. ED Utilization at KVCH 10  Approximately 12,000 visits per year  24 % Medicaid in ED  Highest number of Primary Care Diagnoses seen in our ED are in pediatric patients during regular business hours  Extracting data very expensive in terms of “time” and data analysis  Contracted with EDIE in November, 2011

11. Current Process 11  Patient arrives in ED and are triaged, then Registered  Our Registration system is interfaced with EDIE, so if patient is in EDIE, a fax alert prints in our ED  Registration places a neon pink sticker on the face sheet for all Medicaid patients or all patients who report as self pay but show as Medicaid in our system  Pink sticker alerts nurses to provide mandatory education on appropriate ED usage

12. Patient Education Goal: Help patients understand and use appropriate sources of care  Nursing staff provides brochure and documents in EHR education  Providers utilize EDIE or PRC report to discuss treatment with patients 12

13. Utilizing EDIE for Patients Requiring Coordination (PRC) 13 Goal: Ensure hospitals know when they are treating a PRC patient and treat accordingly  PRC clients = frequent ER users, often narcotic seekers or patients with Chronic Pain  Entered into EDIE by DSHS  ED alerted at Registration by fax via EDIE  Review Care Plan/ Visit History in EDIE  Use care plans to route patient to PCP

14. Utilizing EDIE for Patients Requiring Coordination (PRC)- Cont. 14  Case Management Available 10 AM-6PM  After hours, patient information kept in a MD notebook  Case Management rounds daily, follows up with patient for PCP appointment and care coordination  Case Management updates care plan/EDIE as outlined by ED provider and nurses  All PCP’s receive electronic notification of patients seen in ED via email

15. Questions?  509-962-7439  edavis@kvch.com  509-962-7320  rholden@kvch.com 15 Eric Davis, RN ED DirectorRhonda Holden MSN, CNO