Identify Metrics for Evaluation

Vanderbilt Discharge Management System

Standard Rollout Process

Discharge Management Transport service to coordinate patient discharges requiring EMS services, to centralize/standardize the process, establish accountability, and increase patient throughput.

Stakeholders include: Patients, Case Managers, Social Work, Nurses, Admitting, Program Pilot to Receiving Facilities, begin Ambulance Services, LF Billing December 1, 2009

Meet with Stakeholders MUST HAVES throughout November (Figure 1) 2009 (X) Incorporate evidenced based practice (X) Flow chart process MUST PICK AT LEAST 7 (X) Identify metrics for evaluation WAYS TO DELIVER (X) Identify who needs education on initiative INFORMATION FOR AT (X) Assign Accountability and clear timeline LEAST 7 DAYS Perform (X) Develop plan for sustained success SWOT ( ) Webinservice (X) Identify Methods for content delivery (Figure 1) (X) Leader rounding on Analysis initiative ( ) Post metrics and measurements ( X ) Change of Shift Report (X) Formal in-service to staff Develop (X) E-Mail to Staff ( ) E-Mail to Physicians Action Plan (X) Add to Initial Competencies Debrief ( ) Add to Annual Competencies (X) Cover in Staff Meetings ( ) Cover in Unit Board Meeting ( ) Send out in Friday Communicate Communication from Manager Plan (X) Post flyers on initiative on unit ( ) Recruit unit champions / Chang superusers from staff to es promote initiative Need ( ) Show video of role playing Implement to best practice Action Plan Be made?

Adjust

Case Managers and/or Social Workers will contact Discharge Transport Management (DTM) via phone number 322-7433 (2-RIDE) for patients requiring Ambulance transport post discharge from Vanderbilt

Provide DTM patient demographics and any specialilized needs (bariatric, Ventilator, etc)

Is Preauthorization for Y transport required?

-*Insurance vendor dependant** --Vanderbilt Alternate N funds required?

Convalescent Ambulance Vanderbilt Discharge Expectations Service is notified and transport arranged 1. EMS crew will be bedside within 1 hour of Vanderbilt discharge request 2. DTM will approve an EMS vendor priority/call order unless specifically specified by CMS contract Discharge Expectations 4. Discharge transports that meet medical necessity or met? that will be greater than 4 hours by ground may be referred to Lifeflight Business office for air transport consideration. 5. Transport Coordinator will be on site Monday – Friday from 9a – 5p. After regular business hours, Event logged in weekends and Holidays discharge requests will be Discharge answered by OEC on duty staff Transport database

4/7/2018 Page 4 Identify metrics for evaluation: The patient will leave the institution via ambulance within one hour of DTM being notified that the patient is ready for discharge. The following metrics will be tracked once standardized process is implemented:

 Number of patients utilizing ambulance services by date/time

 Response time of ambulances

 Time from discharge orders till leave(Throughput)

 Type of calls by transfer location (where patient’s going- opportunity to contract) / Focus study-high service areas

Identify who needs education on initiative: Case Managers Social Workers EMS Providers LF Communicators (after regular business hours)

Assign accountability and clear timeline:

Action Person Assigned Timeline Status

Meet with director of critical Brent Lemonds, August 26, 2009 completed transport services discuss Valerie Riebli, Jeanne need/goals/expectations Yeatman

Meet with CNO discuss Brent August 26, 2009 completed feasibility and approval Lemonds, Valerie Riebli,

4/7/2018 Page 5 Action Person Assigned Timeline Status

Pam Jones

Meet with administrative Brent Lemonds, August 27, 2009 completed director for clinical Valerie Riebli, Jeff operations improvement Gray, June Bowman

Develop standard roll out Jeff Gray, Valerie August 27, 2009 completed process Riebli

Perform SWAT Analysis Jeff Gray, Valerie Riebli, August 28, 2009 completed Brent Lemonds

Collect available Valerie Riebli September 8, 2009 completed information- Ron Fortenberry

Develop business proposal Valerie Riebli, Brent August 27, 2009 completed Lemonds

CNO approval Brent Lemonds, September 22 completed Valerie Riebli

Create education plan for Valerie Riebli, Brent September 29, 2009 completed implementation/discuss Lemonds, Jeff Gray how to hardwire (PowerPoint)

Present to Ron Fortenberry Valerie Riebli, Brent October 7, 2009 completed Lemonds, Jeff Gray

Present to Kimberly Harris Valerie Riebli, Brent October 7, 2009 completed Lemonds, Jeff Gray

E-mail June Bowman Jeff Gray, Brent October 15, 2009 completed PowerPoint on DMS. Lemonds

Meet with Case managers Valerie Riebli October 7, 2009 completed and Social Workers to introduce process

Move David Russell to Full Jeff Gray October 25, 2009 complete time DTM position/development

Create DTM database and Jeff Gray, David October 30, 2009 complete DTM office process Russell

4/7/2018 Page 6 Action Person Assigned Timeline Status

Implement process on Jeff Gray November 12, 2009 complete select units for testing (Round wing, Emergency Dept)

Meet with Convalescent Jeff Gray November 30, 2009 Complete EMS providers to explain discharge expectations and implementation timeline

Educate OEC on after Jeff Gray, David November 30, 2009 Complete hours discharge transport Russell, Shift process Supervisors

Incremented “Go live” Jeff Gray, David December 1, 2009 Complete Russell

Meet with Adult ED staff David Russell December 14-18th Complete and Case Managers/Social workers at December staff (4 staff meetings) meetings

Meet with Case Managers David Russell January 12th Complete and Social workers at January Staff meeting

Review collected data, Jeanne Yeatman, December 1, 2009 On going evaluate process and Brent Lemonds, Jeff issues. Gray

Review monthly statistical Jeff Gray On going data and staff feedback to evaluate business improvements/needs

4/7/2018 Page 7 Develop plan for sustained success: sustained success will be achieved through ongoing leader rounding for outcomes, incorporation of education into orientation pathway, at least yearly education to staff, sharing of outcomes data with staff linking them to the initiative.

Identify Methods of Content Delivery: See figure 1 for summary.

PDSA:

What are we trying to accomplish? Establish accountability, support throughput, and standardize the process of patient discharges using EMS services.

How will we know that a change has occurred? Lifeflight communications will document time of EMS response. EMS response time will be a metric for evaluation .

What changes are made that will result in improvements? Centralized communication through DTM and queriable data collection and reporting.

4/7/2018 Page 8