Scripps Mercy Hospital Chula Vista Improved Communication Through

Scripps Mercy Hospital Chula Vista Improved Communication Through Multidisciplinary Huddles (MDH) Results in Reduced Patient’s Length of Stay Sussie Pangcog, MSN; Sonja Mc. Allister MSN, CNS, CCRN-K; Carly Blair, RDN; Michele Tsugawa Billand, Pharm. D. ; Steve Gilbody, MBA, BSN, RN, CCM; Julia M. King, PT, CEES; Kimberly Rodriguez, BSN March 22, 2019

Scripps Mercy Hospital – Chula Vista - 183 Licensed Beds Emergency Department General Medicine Specialties Acute Care Beds - Medical/ Surgical - Oncology - Telemetry/ Step Down - Intensive Care - Maternal Child Health

Background • Inpatient length of stay (LOS) nationally averages 5. 3 days at a cost of $377. 5 billion dollars annually. • In 2017, our community hospital’s LOS was 4. 07, below the average however we felt there was still opportunity to improve. • Nurses identified fragmented communication between disciplines as a contributor to LOS.

Background • Historically, various methods of communication trialed • 2013 - 2015 Care Management Rounds • 2016 Patient Care navigators converted to Care Managers, floor based, case load 20 -25 patients • 2017 • Kardex in each chart • Ingenious Med Bills (IM Bills) at SD only • Bedside huddle for all new admissions (SD) • Centricity EHR

NEXT Exceptional care, for every patient, by every caregiver, every time • December 2017 Model Care is launched at Mercy SD as System Pilot unit • January 2018 Mercy CV 4 th floor launched pilot Model Care • Multidisciplinary Huddles an element of Model Care

Multidisciplinary Huddle (MDH) Ø • Purpose To improve the patient’s experience and reduce the duration of a patient’s stay in the hospital by improving communication among disciplines and identifying barriers to their discharge Ø • Outcome Specific, clear next action (What, Who, and by When) to progress the patient’s care • Shared understanding among care team members about the patients on the unit and their daily needs • Strive for 100% of patients on the unit are reviewed, 7 days a week

MDH • • Structured Consistent • Time, Location, Attendees, Report • • Identify & discover barriers to discharge Communicate with team to address barriers

MDH • • • Standardized daily time – 1000 Prep work MD Schedule

MDH Standard Work

MDH Dedicated Board

MDH Report

MDH Evolution of Engagement • • • Major Change for everyone Cautious engagement by all disciplines Time consuming Staff availability Physician buy-in and schedules

MDH Evolution of Engagement • Scripps committed to improving patients’ care • Staff including all disciplines committed to improving communication • Physicians committed to creating schedule that hospitalists would keep • MDH implemented with structure, discipline and accountability

MDH Significance • Utilizing MDH, interdisciplinary communication has improved and LOS has decreased. • A Charge Nurse leading the structured MDH has improved the average LOS by 10%. All disciplines involved believe that MDH is a valuable venue for discussion as well as discovery and early mitigation of patient issues.

MDH outcome • All disciplines finding MDH is “doable” • 30 min time commitment met • Early Collaboration • Follow-up more quick for timely discharge • All disciplines involved in creation of plan of care • Proactive and better understanding of patient’s needs

MDH Significance

MDH Team Comments

Next Steps • • Weekend coverage same as weekdays Floor based Case Managers and Social Workers Physical Therapies floor based All Patients included

Acknowledgements • • • Sister-hospital, Mercy SD • Patient Care Managers Partners in Care – all our disciplines Physicians, for close collaboration to make it work

References www. healthcatalyst. com www. beckershospitalreview. com

Contact Information Sussie Pangcog, MSN Sr. Director Patient Care Services Pangcog. Sussie@Scrippshealth. org Sonja Mc Allister, CNS Mc. Allister. Sonja@Scrippshealth. org