Main Title, 24 pt, bold, Sentence Case Sub-Title, 18pt, bold ...

Main Title, 24 pt, bold, Sentence Case Sub-Title, 18pt, bold ...

GASTROINTESTINAL SURGERY READMISSION REDUCTION Scholars | Nicole Chaumont MD and Stephanie Lumpkin MD Project Manager | Sabrina Vereen IHQI Faculty Coach| Matt Nielsen MD Sponsor | Alessandro Fichera MD Medical Student | Clark Howell Additional Team Members and SMEs: Donna Brickman, Tezrah Garner, Maureen Haro, Jennifer OBrien, Emily Hoke, Lisa Jenkins, Kim Johnson, Gretchen Lee, Lara Leininger, Terri Ottosen, Heidi Prestemon, Agnes Royal, Ayana Simon, Jamie Stewart + Patient Advisors (3) 9.19.19 IHQI Improvement Scholars Symposium Add Silhouette

UNC HEALTH CARE SYSTEM A fine balance between sickness and health 3 UNC HEALTH CARE SYSTEM Number of Readmissions Per Service FY 2017 600 500 400 300 200 100 0 1 https://www.ncbi.nlm.nih.gov/pubmed/22067174

Baseline Rate 20.7% What were we trying to accomplish? Improve quality of discharge summaries Decrease variability in After Visit Summary Engage all stakeholders Create a patient-centered AVS

Reduce Readmissions UNC HEALTH CARE SYSTEM 6 October 1, 2018 - August 18, 2019 U tiliz a tio nR a te UNC HEALTH CARE SYSTEM Discharge Summary Template Utilization

N= 100% 80% 60% 40% New Interns on Service 20% 0% Week Number 7 UNC HEALTH CARE SYSTEM

Perceived Impact I honestly wish other services would standardize their instructions to this level, I think it is important to help the patients receive the information they need so they can be comfortable and safe going home. These changes have made my life easier as an intern trying to discharge patients and I think will help patients have consistent and correct information. 8 UNC HEALTH CARE SYSTEM Life Cycle of an AVS Golden Ticket AVS

Intern or APP Nurse A million other consultants and ancillary services Patient UNC HEALTH CARE SYSTEM REDUNDANT INFO ERRORS MISSING THE BASICS 10 Stakeholder Engagement

UNC HEALTH CARE SYSTEM I keep the discharge instructions at my bedside. - Patient Advisor 11 UNC HEALTH CARE SYSTEM After Visit Summary AVS Template Use % Utilization Rate March 24, 2019 - August 18, 2019 100% 80%

60% 40% More complexity in implementation slower to reach max compliance. 20% 0% 1 2 3 5 6

7 8 9 13 14 Week Number 16 17 18

19 20 21 22 23 24 UNC HEALTH CARE SYSTEM Improved Workflow = Happier Workers Daily Pages Stable

Billing Queries Decreased by 40% Improved Patient Call Logs 14 UNC HEALTH CARE SYSTEM Gastrointestinal Surgery Readmissions 35% 30% 25%

20% 15% 10% 5% 0% Jul-18 Aug-18 Sep-18 Oct-18 Nov-18

Dec-18 Jan-19 Feb-19 Mar-19 Apr-19 May-19 Jun-19 15 UNC HEALTH CARE SYSTEM Sustainability and Spread Resident training Atti tude Shiftand

Buy-in Compliance Audits Dotphrase adaptability Staff Process Senior Leaders Measurable Outcomes PIPS Data Benefits - Pages - Queries Adopted from NHS Sustainability Model

Organization UNC Goals Transitions Team Service Line Leadership Team UNC HEALTH CARE SYSTEM Standardized the Tool, Now Standardize the Process AVS as a Tool After Visit Summary RN Teachback Patient Retention

of Information Ideal timing of education 17

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