Cedars-Sinai Medical Center

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A BI-WEEKLY PUBLICATION FROM THE CEDARS-SINAI CHIEF OF STAFF April 25, 2014 | Archived Issues

Recognition for Chugh, Marban, Metz, Sandler

Physician News

Eduardo Marbán, MD, PhD, and Sumeet Chugh, MD, have won awards from the American College of Cardiology; Richard J. Metz, MD, is being honored by the National Hemophilia Foundation; and Howard Sandler, MD, will receive an award from the Honors Program at the University of Connecticut.

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Meetings and Events


Grand Rounds

Click here to view upcoming grand rounds.


Upcoming CME Conferences

Click below to view a complete list of all scheduled Continuing Medical Education conferences.

CME Newsletter - April 2014 (PDF)


Milestones

Do you know of a significant event in the life of a medical staff member? Please let us know, and we'll post these milestones in Medical Staff Pulse. Also, feel free to submit comments on milestones, and we'll post the comments in the next issue. Click here to email us your milestones and comments.

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Share Your News

Won any awards or had an article accepted for publication? Share your news about professional achievements and other items of interest.

Click here to share your news

High-Quality Care Doesn't End With Discharge

A new collaboration between Cedars-Sinai and five highly vetted home health agencies seeks to ensure that patients discharged from the hospital to home health receive the highest-quality care.

The program, called Enhanced Home Health 2.0, went into effect March 3. It provides full-time, on-site liaisons from Accredited Home Health, Assisted Home Health, Caring Like Family Home Health, Dynamic Home Care and Universal Home Care, who meet with patients before discharge to prepare them for the transition to home-based care. The liaisons are at Cedars-Sinai on weekdays from 8 a.m.-6 p.m.

Early results show the arrangement's promise. Patients in a 2013 pilot study of the program were more accepting of home healthcare and received the services more quickly.

The five agencies follow an evidence-based protocol that includes seven "touch points," or points of contact, that home health staff members make with patients in the first two weeks after discharge to address issues, answer questions, identify problems and schedule visits. Among the touch points are "tuck-in" phone calls on the first and second Fridays after discharge to ensure patients' needs are met before weekends, when closed physician offices make hospital readmissions more likely.

"In the old days, a newly discharged patient who became short of breath at 9 p.m. on a Saturday would call 911 and end up back in the hospital Emergency Department," said Neil Romanoff, MD, MPH, Cedars-Sinai vice president for Medical Affairs. "Now, that same patient can receive a 'tuck-in' phone call on Friday from her home health nurse, who can identify red flags and help her avoid the breathing problems that would lead to a 911 call."

Trying to Reduce Readmissions

Cedars-Sinai has been investigating ways to reduce 30-day readmission rates for several years and began studying the impact of post-discharge home healthcare in December 2011. An early analysis showed patients and families often turned away services and that physicians were often unresponsive when agencies called with questions.

In January 2013, Cedars-Sinai launched a six-week pilot program with four home health agencies that agreed to make frequent contact with patients in the first two weeks after discharge. Readmissions dropped by 32 percent in the first two weeks after discharge, but when the pilot was discontinued, the rate of readmissions returned to the higher baseline rate.

A Cedars-Sinai Performance Improvement committee decided to try a new approach that involved collaborating with a small group of home health agencies that would work with the hospital to improve outcomes. Romanoff proposed a style of collaboration based on a model of vendor relationships he learned about while serving as a judge for the Malcolm Baldrige National Quality Awards, he said.

"It's all about creating win-win relationships with your vendors," Romanoff said. "In win-win relationships, each party defines what it wants and needs from the relationship to be successful."

Cedars-Sinai sent requests for proposals to 200 of about 700 home health agencies in its service area, said Neema Haria, MHSA, a project manager in Cedars-Sinai Performance Improvement. After considering factors such as readmission rates, the use of information technology systems and capacity, the selection committee narrowed its choices to 13 home health agencies and talked to their representatives about how to make the arrangement work, Haria said.

"We told them what we need and then asked what they need from us," Romanoff said. "A lot of what they said was basic, like 'We need an accurate face sheet' or 'We need to know, when patients are being discharged, if they are going home or to their sister's.' We all learned a lot from those discussions."

Cedars-Sinai selected five home health agencies for the arrangement. To align the agencies' values with Cedars-Sinai's, agency employees went through a hospitality service recovery program that focuses on how to deal with challenging situations. In addition, the agencies' on-site liaisons went through an orientation process that included health clearances, criminal background checks and signed confidentiality agreements so they could have remote, read-only access to patient health information on CS-Link™.

Patient assignments are rotated among the agencies unless patients or their physicians express a preference for a particular home health agency. Physicians may refer patients to other home health agencies, but only the five agencies have on-site liaisons and have agreed to follow the protocol of seven touch points.

Most Referred Patients Use the Service

So far, about 70 percent of the 475 patients referred to home health have received services from the five agencies, said David Esquith, LCSW, Cedars-Sinai's manager of Medical Social Work. The remaining 30 percent either chose outside home health agencies or declined the service.

"With outside agencies, a patient in need of home health services goes home and then a nurse comes out, does an assessment and starts putting everything in place," he said. "Having the agency liaison see the patient before discharge means the home health agency gets all the information it needs ahead of time, so there is less of a time gap between when the patient gets home and when services begin.

"There's also a much higher acceptance rate, because patients are sometimes wary when they get a call from a nurse at home," he said. "But if they're introduced to a liaison in the hospital, they tend to be more open about having a nurse come out."

As part of the agreement, Cedars-Sinai and the five agencies agreed to monitor one another on quality and performance. To help establish a spirit of cooperation among the agencies, Cedars-Sinai averages their readmission rates together.

"When we picked these five agencies, they were competitors, but they have come together as a group and are supporting each other when they need it," Romanoff said. "It's truly a team effort."

Physicians can refer patients to Enhanced Home Health using the home health referral available on CS-Link. For more information, please contact Case Management at 310-423-4446.