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https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/381bc35b92b4ff36a91a15c953011a1f.pdf?Expires=1712793600&Signature=pZA%7E0QvTQO33J7s9cmyPXx%7EbUzHt2JWKFENoFlZGQx3DG%7ECl1dwSLBE%7EvMOxkjtHgEgmvQJP9NPNqzZNWVFRAZWlGO9sNzCcYwUkYtBjuPzcbhmP6jX5fq4jLdpwEUWI9L4TUYqFoRa8gBJgzwqoKIn0RLSa0zzbSpUoHayZZJ037kIVMCcZrIE0DsG59mc7XLK194APP2D%7EBW9jD-y5w%7EV%7EtKAbk9OSRccmBKDTRdAwwW59h2t7h3b5tQ7jZ1lmMDDbYdZeEpg1gYoM4fHacunkHSDHTw4xFHa4lNfGegZEFRUfW3ai-LIrNexr9JcCZVqp6O3S1D%7EeSoAnABgkIQ__&Key-Pair-Id=K6UGZS9ZTDSZM
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Decreasing Readmissions in Cardiac Surgery
Marjorie Serrano MS, RN
Introduction/Problem
Readmissions are expensive and often avoidable patient care outcomes. Annual Medicare costs related
to potentially preventable readmissions are estimated at $17 billion. In 2017, CMS began assessing a
penalty for excessive readmissions for CABG/Medicare patients. The cost of this penalty for BIDMC in
2018 was almost $900,000. Between 2013 and 2016, BIDMC was an outlier, with a readmission rate of
16.6%, compared to a national rate of 13.8%. We had a higher rate of readmissions than the rates of our
academic medical center neighbors.
Aim/Goal
The goal of the project is to decrease the readmission rate of CABG/Medicare patients at BIDMC. CMS
updates the data each July, with the current lookback period from 7/1/2014-6/30/2017. We began the
project in October, 2016.
The Team
Barbara Barrett BS, RN
Mark Courtney NP
Marnie Crowley MS, RN
Lisa Demanche MS, RN
Michelle Doherty MS, RN
Jennifer Dundon, PA-C
Peter Germond PA-C
Kamal Khabbaz MD
Gail Nadeau BS, RN
Barbara Regan BS, RN
Marjorie Serrano MS, RN
John Whitlock MS, RN
Jesse Yang MD
Julius Yang MD
TAP TO GO BACK TO
KIOSK MENU
The Interventions
Real-time analysis of readmissions and data at our monthly meeting
Clinical
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Prevent symptomatic volume overload/depletion after discharge
•
Standardize diuresis medications while inpatient
•
Extend length of stay for volume management
•
Standardize time of weight measurement and documentation of weights on
Farr 8
•
Cardiology consult for heart failure patients while on Farr 8
•
Two week post-discharge cardiology follow-up for heart failure patients
–
Prevent symptomatic atrial fibrillation (AF) after discharge
•
Literature search for pharmacological prophylaxis
•
Standardize management of inpatient and ED management of patients with AF
•
Evaluate risk factors for AF
–
Prevent readmissions due to anticoagulation issues
•
Closer telephonic monitoring after discharge
•
Review best practices
–
Prevent readmissions due to surgical site infections
•
Develop criteria for use of Prevena dressing
•
Work with infection control to assess current practices and implement updated
regimens and practices
Follow-up
–
Create preferred provider network of skilled nursing facilities (SNFs) and visiting nurse
associations (VNAs)
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New position for office-based nurse to provide closer follow-up for discharged patients
–
Utilize CDAC for management of patients with volume and rhythm issues, instead of
inpatient admissions
–
PACT program
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Care Transitions program
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Encourage discharge home instead of SNF for patients who live alone
Other interventions
–
Preoperative risk assessment for targeted interventions
–
Investigate best practices at other medical centers and Advisory Board
recommendations
�Decreasing Readmissions in Cardiac Surgery
TAP TO GO BACK
TO KIOSK MENU
Marjorie Serrano MS, RN
Results/Progress to Date
These rates include readmissions only to BIDMC. CMS includes all cause readmissions to any hospital.
Lessons Learned
The actual number of readmissions is small. The rate varies, depending
upon the volume of CABG/Medicare cases (the denominator) for the
month. A rise in surgical site infections had a large effect on the
readmission rate. Through July, 2018, we have not reached our target
rate.
Lack of real-time data from CMS makes it difficult to assess interventions. Small changes in the
numbers of readmissions have a large effect on the rate. Because of the 3 year rolling look-back, it
takes a long time for the CMS metric to reflect improvement.
The interventions cover many of the reasons for readmissions, making the scope of this project
enormous.
We have developed relationships with our SNF preferred providers. We now have improved follow-up
of our patients who go to these facilities.
Next Steps
Continue all current interventions and evaluate their effectiveness.
Expand preferred provider network to VNAs.
Give preferred provider pamphlet to targeted patients preoperatively.
Direct postoperative patients who need SNF placement to preferred providers.
For more information, contact:
Marjorie Serrano MS, RN Nursing Director Farr 8 and CVICU mserrano@bidmc.harvard.edu 617-754-3173
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Marjorie Serrano (<a href="mailto:mserrano@bidmc.harvard.edu" target="_blank" rel="noreferrer noopener">mserrano@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Surgery
Cardiac Surgery
Nursing
Health Care Quality and Safety
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Barbara Barrett
Mark Courtney
Marnie Crowley
Lisa Demanche
Michelle Doherty
Jennifer Dundon
Peter Germond
Kamal Khabbaz
Gail Nadeau
Barbara Regan
Marjorie Serrano
John Whitlock
Jesse Yang
Julius Yang
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Decreasing Readmissions in Cardiac Surgery
Date
A point or period of time associated with an event in the lifecycle of the resource
2019
Format
The file format, physical medium, or dimensions of the resource
pdf
Effectiveness
Efficiency