Submitted by James R Gengaro, DO, Internal Medicine, Campus Chief of Hospital Medicine, Riddle Hospital
The Hospitalist Medicine Service (HMS) at each MLH campus consists of doctors who want to lead their medical teams with high quality patient centered care. Sometimes review of the data reveals room for improvement. Here are some Quality and Process Improvement (PI) projects occurring at MLH in which HMS physicians are participating and championing.
Venous Thromboembolism (VTE) which includes Deep Vein Thrombosis or Pulmonary Embolism, can occur in medical patients who are hospitalized with either previous medical history or acute medical illness that increase risk to develop clots. Physicians need to assess their patients for this risk so that proper prophylaxis is put into place. The literature is rich with recommendations on which patients should get mechanical prophylaxis, which should get chemoprophylaxis and who may not need any. Although all VTE is not preventable, a solid process can maximize the number of patients on the appropriate prophylaxis. HMS was happy to help champion a VTE PI team which includes other physicians, nurses, patient safety officers and PI engineers. This team has already re-designed the medicine progress notes with a VTE risk assessment and VTE treatment section to better document the VTE prophylaxis plan. The PI team also continues to work with their IT partners to update the VTE order sets in Cerner SmartChart so the work flow will prove most effective.
HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) are patient surveys which assess the patient experience. Patient centered care models in the hospital aim to improve the patient experience including respect, shared decision making, improved transition of care and overall efficiency. HMS and other physicians have participated in a pilot program at Riddle Hospital, on 2 nursing units, where they have put the patient in the center of rounding. The physician and the nurses round together at the bedside in an effort to improve communication between the physician, the patient and the nurses. This helps to better explain to patients and their families the goals of the hospitalization including work up, treatment and ultimately discharge. Preliminary data has already shown improved HCAHPS scores in the physician communication, nursing communication and discharge process domains on these nursing units. Plans are in development to roll out the patient centered rounding model to all floors, all physicians and all patients at Riddle Hospital.
Additionally, a new provider version of “I am the Patient Experience” has been developed by physicians including 2 members of HMS. The program, soon to roll out across the system, was beta-tested with Lankenau and Riddle hospitalist groups. The feedback these groups provided have helped to improve the effectiveness of the course.
Finally, when hospitalized patient care is at its best, patients are discharged from the hospital and are safely transitioned to the outpatient environment. HMS continues to work specifically at the goal of reducing readmissions back to the hospital. This is best accomplished with targeted communication between the HMS physicians and the patient’s primary care physician. This includes availability of discharge summaries on the day of discharge whenever possible, phone calls directly to the PCPs on day of discharge for high risk patients, careful reconciliation of medications using the EMR to compare home med lists with the discharge medication list and electronic prescriptions to the patient’s pharmacy of choice.
As we continue to monitor quality metrics, HMS hopes to lead by example to ensure safe and efficient care for our hospitalized patients at MLH.