1. Rehabilitation Role in Bedside Rounding Christina Pedini, MSPT, GCS Director of Rehabilitation, University of Maryland Upper Chesapeake Health

2. Session Objectives Attendees will: Improve understanding of role of rehabilitation professionals in changing models of healthcare Explain benefits of interdisciplinary model of care to enhance overall quality of healthcare outcomes Understand use of metrics to measure improvement of outcomes, patient experience and efficiency

3. Healthcare changes in the United States Affordable Care Act The Affordable Care Act was passed by Congress and then signed into law by the President on March 23, 2010. On June 28, 2012 the Supreme Court rendered a final decision to uphold the health care law.

4. Maryland Health Services Cost Review Commission (HSCRC) Global Budget Model- July 2014 Quality Measures Readmission Rates Maryland Hospital Acquired Conditions (MHAC) Potentially Preventable Complications (PPC’s) Quality Based Reimbursement (QBR) Core Measures Patient Satisfaction Scores (HCAHPS)

5. Patient Experience Patient Satisfaction Scores (HCAHPS) Cleanliness and Quietness Communication about Medicines Communication with Doctors Communication with Nurses Discharge Information Overall Rating of this Hospital Pain Management Responsiveness of Hospital Staff

6. Rehabilitation Role in Quality Measures 65 Potentially Preventable Complications: Aspiration Pneumonia In Hospital Trauma and Fractures (Falls) Decubitus Ulcer Urinary Tract Infection Acute Mental Health Changes Compliance with Hand Hygiene, Equipment Cleaning: C Diff Colitis Moderate Infections Post Operative Wound Infections -PPC’s, HSCRC

7. Six Principles for Change for Bedside Care Teams 1.The patient and family are essential members of the core care team. 2.Bedside care team members are fully engaged at the broadest scope of their practice. 3.The bedside care team is focused, highly effective and autonomous, coordinating communication with the patient/family. 4.Evidence-based guidelines that improve care are developed and consistently followed by every bedside care team member. 5.Technology replaces some clinical tasks, augmenting decision- making and complementing the clinical judgment of the care team. 6.Patients needing acute care move safely through the health care system. -2014 White Paper: Reconfiguring the Bedside Care Team of the Future. (2013, November 8). Retrieved from http://www.aha.org/

8. Patient and Family Centered Care Bedside Rounding Video http://vimeopro.com/user22821689/university-of-maryland- upper-chesapeake-medical-center

9. Rehab Discharge Recommendations Why is rehab participation important? Patients are 2.9 times more likely to be readmitted if physical therapy discharge recommendations are not followed Smith, B. A., Fields, C. J., & Fernandez, N. (2010). Patient risk of readmission is higher when acute care physical therapists' discharge recommendations are not implemented. Physical Therapy, 90(5), 693-703.

10. Bedside Rounding Structured Format

11. Rehab Questions (10-15 seconds) Consider these questions and compare to patient’s baseline level: 1.Is the patient moving around (mobility)? 2.Is the patient able to care for themselves (ADL’s)? 3.Is the patient able to eat, drink and communicate? Representation can be by PT, OT, or SLP…. Ask for consults in rounds if any doubt.

12. Time Dedicated to Rounds Ideally 8-14 patients Chart review- completed prior to rounds 30-45 min Time to complete rounds- 45-60 min

13. Overall Program Metrics Staff Survey- Improvement in all areas: Positive and effective communication Care team quickness to assist each other Patients and families effectively updated Comfort with initiating difficult conversations on behalf of patient Smoothness and efficiency of work Patients and families preparation for discharge

14. Pre-Implementation of Rounds Post-Implementation of Rounds 433% improvement in “Strongly Agree” responses Communication with Physician

15. Pre-Implementation of Rounds Post-Implementation of Rounds Times Calling Physician

16. Pre-Implementation of Rounds Post-Implementation of Rounds Staff Perception of Time on Tasks

17. Overall Metrics HCAPS Meeting 5/8 Domains on Pilot Unit Communication with Nurse Responsiveness of Hospital Staff Cleanliness and Quietness Communication About Medicines Overall Rating of Hospital

18. Overall Metrics Ongoing Measurement Length of Stay Readmission Rate Case Mix Index Nursing Care Hours per Patient Days

19. Rehab Metrics Missed Visit Documentation Screening (No Service Needed) – Before rounds: 14% of all referrals on Pilot Unit – After rounds: 7% of all referrals on Pilot Unit Medically Excused – Before rounds: 47% of all referrals on Pilot Unit – After rounds: 46% of all referrals on Pilot Unit Time Spent on Missed Visit At least 30 min per patient

20. Other Impacts Observations Engaged patients and families Enhanced nursing role in mobility Staff holds each other accountable Patient and family can correct information in real time Greater accuracy in appropriate referrals

21. Challenges Physician Engagement Change in workflow Resistance initially Training and expectations- leadership Rest of Team Engagement Immediate nursing support, others varied Time commitment Productivity/cost- Global Budget Training and expectations- leadership Rollout to Rest of Hospital

22. Advocating for Rehab, Advocating for Patients http://quotesology.com/mother-teresa-quotes