CMO Message: June 2024

June 11, 2024

1)     Why not home? – Therapy Note Changes! You may have noticed some changes to therapy notes recently! Instead of naming a particular discharge disposition in the therapy note, therapists document their clear input on post-acute level of therapy, equipment, and any other therapy related needs. This change encourages the care team to determine the least restrictive level of care that is clinically appropriate for each patient’s needs based on recommendations from our therapists. We ask our care teams to thoughtfully engage in asking “why not home?” to support the patient’s transition of care and to review the attached practice alert and job aids for information on how to interpret next site of care therapy recommendations.

 

2)     Ongoing work with length of stay Happy birthday to in-person Multidisciplinary Progression to Discharge Rounds (MPDRs) which turn one this month! We have hired a leader for our post-acute collaborative to help establish and maintain relationships with post-acute resources in the community, and hope to see our observed to expected ratio (O:E) to SNF, rehab and others decline in the coming months.

a.      Lenght of Stay (LOS) at St. Peter for May looks to come in around 6.4 (below goal!), which is the lowest so far this year. Opportunities at St. Peter include:

·        O:E to home (75% of our patients) which has hovered around 1.2-1.25 so far this year.

How can we get medically ready patients home closer to when we expect them to go home?

·        Ensuring Medically Ready for Discharge (MRD) date is recorded as accurately as possible (the system allows for either an estimate i.e. 2-4 days, >5 days or NOW for patients without a medical necessity for continued inpatient stay)

·        Placing orders for discharge as early as possible on the day of discharge to allow for discharge process ahead of the rush (ideally before 10 a.m.)

·        Planning ahead for discharges over the weekends (have imaging, consults, and any necessary coordination completed before the weekend when these items may be less readily available)

b.      LOS at Providence Centralia for May is expected to be around 5.03, which is above goal and higher than last month (4.6). Centralia has been challenged with a lower census and more non-medical necessity/longer length of stay patients particularly in May. Opportunities at PCH include:

·        Centralia continues to meet or exceed many of its goals including discharge efficiency >25% and Mean Turn Around Time (TAT) of <2 hours (meeting for 60+% of patients)!

·        Centralia O:E to home increased for May, where it had been less than one for April.

How can we get medically ready patients home closer to when we expect them to go home?

·        Ensuring review and hard discussions for Non-Medical Necessity (NMN) patients which make up between 20-25% of census on some days – this is best done by using Escalation Criteria and bringing patients to Complex Case Rounds/Review for review and discussion (escalate patients by bringing them to Case Management team for review!)

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