Acute Care Hospitalization

renerian, BSN, RN · Nov 1, 2005

Wow that is a question that is not easy to say as I am getting ready for work this morning.

1. Develop disease specific standards of practice

2. Develop patient ed tools for the same

3. Develope orientation and staff ed on both of those items

4. Use the OBQI committee to help assist with this process

5. Audit files to see if all this worked

6. Revise if it did not

7. Utilize OBQI reports to help decide what project to do first

Etc. Huge project. I have done is a couple times elsewhere but am starting to do it at my part time job again.

Does this help.

ren

homesrus · Nov 1, 2005

We are starting with a chart audit for a quarter. We will start from there. Some agencies are making more frequent visits in response to calls from patients . We have 24 hour call but do not encourage visits after midnight. Ocassionally we have to go out but most things can be taken care of on the phone. Maybe we will have to consider increasing those visits

renerian, BSN, RN · Nov 1, 2005

What does your adverse events reports tell you? That is a good place to start......

ren

amesly15 · Nov 3, 2005

Our Acute Care Hospitalization rate is 41 % ..higher than the state and national average.

renerian, BSN, RN · Nov 14, 2005

Let me ask a few questions to help clarify:

How large is your service area/people stetched to far.

Are any of your on call, calls landing on the reports/meaning their frequency might be to low.

What do your OASIS reports identify as your top diagnosis/other demographics.

Do you have care paths/tracks?

What is your average LOS?

renerian

Traveler · Nov 15, 2005

One of our biggest problems with hh patients and hospitalization in rural areas is that our local hospital is often treated more as a clinic. The patients know everyone in the ER and the wait is usually minimal. The doctors will often also admit just to "keep an eye" on the patients. It is a small 25 bed hospital that does no surgeries and has no anesthesia. This makes our numbers always higher.

renerian, BSN, RN · Nov 15, 2005

When you do your adverse events audits is there a common diagnosis that ends up going to ER?

How fast are they going to ER?

Is your frequency high enough on the front end to give people information about that diagnosis so they call you rather than go to ER?

I am trying to see if they are just shooting off to ER, calling the agency being directed to go to ER, calling the doc and getting directed to ER, missing or cancelling visits and going to ER.

If you can trend something out you can create care standards to see if that helps. For example if you have a person with CHF once per week is not enough on the front end to teach them everything they need to know about CHF and exacerbations so your frequency can be something like 3 week 2, etc then taper down.

renerian

renerian, BSN, RN · Nov 15, 2005

I forgot to add did you check the Med QIC website? They have some good emergent care audit tools.

renerian

homesrus · Nov 17, 2005

In addition to front loading visits we are also making phone calls to the patients on the days the first week or so after discharge that we aren't in the home. I think you can reduce your rate but everyone, nurse, doc and patient need to agree to making the program work. That's the hardest part, I think.

renerian, BSN, RN · Nov 17, 2005

Good thought on the calls. It is good your agency gives you time to do that. With nurses managing more and more patients it is hard to squeeze time in.

renerian

homesrus · Nov 18, 2005

I think that we continually add to the work and paper load but rarely take anything away. We have an afternoon LPN that has two hours free. We think that with a form that has a set list of questions she may be able to make some of the calls. Then she will have to report the findings to the primary nurse. Don't know if it will work.