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Proven strategies to curb infections, readmissions

Posted Oct 04 2012 3:50pm

by Dana Kellis

PinnacleHealth has undertaken a number of steps to address two areas of opportunity--reducing infections and readmissions.

Reducing infections has been a top priority for the executive and clinical leadership team at Pinnacle for the past several years. Realizing the tremendous negative impact of a hospital-acquired infection on a patient, we take every infection seriously.

First, we monitor our infection rates closely, with the infection control department sending out weekly report cards of infections in every area of the hospital and every type. Post-operative infections are automatically subjected to a 'root cause analysis' in which the clinicians involved with the patient and appropriate experts from the infection control and other departments gather to review the case and identify potential opportunities for improvement.

When a trend is identified for either type of infection or location within the hospital, we assemble operational teams comprised of physicians and infection control personnel to observe processes in at-risk patients and make recommendations to the department for changes. Rapid-cycle improvement methodology is utilized to implement suggested changes and track results. Outside experts are consulted for additional insights as to the problem.

It has been our experience that these trends are often multi-factorial in nature, and require a number of interventions to reverse them.

Our approach to readmissions has not been quite as centrally organized, but has nevertheless been robust. Once again, the key has been to track our readmission rates by physician and by disease state.

Physicians/groups with high rates are identified and engaged in discussions to find ways to address the problem. Nursing homes with high rates also are notified of their status as outliers, and a special team of case managers and executives works with them to implement alternative approaches to end-of-life care, as well as to identify and treat acute deterioration in their patients at an earlier stage.

Post-discharge phone calls to all discharged patients with specific questions about success in starting recommended medications and in attending follow-up appointments with their physicians have proven invaluable in decreasing our readmission rates.

Finally, members of our hospitalist program, which is responsible for caring for up to 70 percent of our inpatient volume, are regularly trained in preventive measures, such as clear communication of discharge plans, identification of a person who can answer questions once the patient has been discharged, and ensuring appropriate arrangements have been made for follow-up care. The program has made a positive difference in our readmission rates.

Dana Kellis, M.D. is senior vice president for Medical Affairs and chief medical officer of PinnacleHealth System in central Pennsylvania.

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