Spaulding Rehab Cape Cod Reduces Adverse Drug Events

ADEs are defined as injuries resulting from the use of a drug. They result in increased morbidity and mortality, prolonged hospitalizations, and higher costs of care. All hospitals, as a condition of their accreditation, must have medication reconciliation programs in place. These programs assure that at each point of care the medications listed in a patient's medical record are cross-checked with an external list of medications obtained from a patient, hospital, or other provider.

But reconciliation programs are merely a first step in a hospital's medication error reduction programs. Spaulding's effort on Cape Cod adds a series of layers over the basic cross-check of medications.

"The first level is 'intervention' - when the pharmacy steps in and acts before the problem reaches the patient. Our pharmacy has led this change," said Linda Melillo, director of patient experience and quality & compliance. "The second level is 'administration' - when the administration of a drug to a patient causes harm. We've been able to reduce both our interventions and administration errors significantly."

The Massachusetts Hospital Association (MHA) is serving as a Hospital Engagement Network (HEN), which is coordinating the efforts of hospitals to reduce inpatient harm by 40% and readmissions by 20% by focusing on 10 targeted safety areas - including reducing adverse drug events. Spaulding Rehab's 61% reduction in ADEs betters the HEN goal of 40%.

Jim Blackwell, RPH, the pharmacy manager at Spaulding Rehab Cape Cod, recently walked through a typical example of how a drug order is written and processed and the problems that can arise.

First, a physician enters the order through a Computerized Physician Order Entry (CPOE) system. CPOEs eliminate the oftentimes hard-to-read handwriting that led to problems. Spaulding Rehab has its core hospitalists on staff who are familiar with CPOE; but when an outside doctor covers on a weekend or off-shift, that physician (a "moonlighter" in hospital lingo) may not be familiar with Spaulding's CPOE. Special attention is given to moonlighter prescriptions.

Once the pharmacy receives the prescription, it reviews it, checking it closely with the patient's transfer paperwork. This step is not as easy as it may sound, Blackwell says, because a patient may have a list of medications he took at home, and another list of medications that were administered in the hospital while at-home medications were suspended.

"Sometimes the discharge summary doesn't reflect entirely what the patient has been taking," says Blackwell. "After we review all the discharge documents, we'll converse with the doctor to discuss any possible drug interactions."

Melillo and Blackwell say that prescriptions entered into the CPOE and the Electronic Medical Record (EMR) can alert the pharmacy to drug interactions and to obvious transcription errors, such as assigning 1000 mg as opposed to 100 mg. But one of the biggest potential problems the hospital faces, and which the electronic systems do not catch, concerns medication orders that are written but which are not administered immediately. For example, a prescription order may be put into the system after 6 p.m. because a patient is in transfer. The computer may default the dose to the next day - 6 a.m. - meaning the patient misses the nightly dose. It's up to the pharmacy team to catch that.

Another factor, Blackwell says, involves a patient's kidney function. The average age of the hospital's patients is 74 and oftentimes their renal system is compromised. Because the majority of medicines are excreted through the kidneys, if the renal function is poor, the medicine is not excreted and it can cause adverse effects; sleeping medications will cause prolonged drowsiness, or the next dose of a medication is administered when the first dose has not yet left the body.

"We often go into the patients profile when the labs are drawn so we can assess the renal function and look at their medications and we know which ones may need to be changed to stop a problem from developing," Blackwell says.

ADMINISTRATION ERRORS
Those interventions are key, but problems can also arise during the administration of the medication, Melillo says.
Nurses administering drugs can be caring for patients that are taking 15-20 medications at once. The system they use requires them to scroll through a series of screens to get the patient's record, drug dosage, record of administration, and more.
"Errors happen when you bypass the computer system, when you 'click through' the screens and prompts," Melillo says. "Also, as we've mentioned, the computer system doesn't catch everything. Sometimes people can get away from using their knowledge and rely on the computer instead, like relying on a spell checker to catch all misspellings."

Because medication administration errors occur at hospitals, Spaulding Rehab Cape Cod formed a Medical Management Committee to work on the issue, leading to the creation of a peer-review panel based on the Ongoing Professional Practice Evaluation model that physicians use.

"Anyone who made an error has to attend the review to help us troubleshoot the system," Melillo said. "It helped us turn the corner."

As one would imagine, anyone who makes a mistake during the course of his or her work - especially when that work involves caring for an ill person - is troubled by it, and may feel apprehensive about admitting error. But the Spaulding system, like many such systems in healthcare, is non-punitive, meaning the system does not exist to mete out punishment but rather to identify why errors occurred and then to fix the systems that led to the error.

"I've been here for 10 years and I let them know - whether it be a pharmacist, RN, respiratory therapist, or another - I let them know that it's not a punitive system," Blackwell says. "Our improvement, in fact, shows an exceptional level of teamwork to help us identify underlying problems and reduce errors."

Thomson Reuters Top 10 Health Systems of 2011

Thomson Reuters Research Identifies Top 10 U.S. Health Systems:

Thomson Reuters released its third annual study identifying the top 10 U.S. health systems based on quality of care, efficiency, and patient satisfaction. [Including Cape Cod Healthcare, Hyannis, MA; CareGroup Healthcare System, Boston, MA; and Partners Healthcare, Boston, MA]. Compared with their peers, the Thomson Reuters 10 Top Health Systems saved more lives, caused fewer medical complications, made fewer medical errors, followed recommended standards of care more closely, released patients half a day sooner on average, and scored better on patient satisfaction surveys.

Tufts’ CLABSI Team Scores Remarkable Success

Anyone who has ever been near a hospital emergency room - due to their own illness or that of a family member, or friend - probably has seen saline solutions or medications delivered intravenously. A catheter is inserted into the arm, a saline bag is hung on a nearby pole, and the "IV drip" delivers fluid quickly and effectively.

But for more serious cases, when a mere drip is not enough, or when the drugs being administered are so caustic they can damage smaller veins, clinicians have to insert a central line into the patient - and that involves entering the jugular vein, or the vein in the chest below the collarbone, or the large vein in the groin.

Any foreign object such as a catheter inserted into a patient may present a pathway for pathogens to enter the body, and large central lines that terminate close to the heart and that remain in the body for long periods of time are no exception. Staphylococcus aureus and Staphylococcus epidermidis sepsis are serious, potential consequences of central line insertions; nearly 13,000 such "central line-associated bloodstream infections" (CLABSIs) occur each year in the U.S., sometimes resulting in fatalities and always resulting in additional cost per patient, ranging up to $40,000 by some estimates.

But the number of CLABSIs is dropping rapidly across the U.S. because of the efforts that hospitals have undertaken.

At Tufts Medical Center (Tufts MC) in downtown Boston, the small team that was assembled to reduce, or eliminate, CLABSI has had remarkable success. Since 2010, through a daily effort that has involved the hospital's most senior leadership, nurses at the bedside, and assistive personnel, Tufts Medical Center reduced central line-associated bloodstream infections by 80%. In some of its units, Tufts MC has had 600 and 800 CLABSI-free days - that's zero infections for every day a patient has had a central line inserted into his or her body. The hospital's CLABSI rate of 0.69 per 1000 central line days is far below the national average.

Dorothy DiDomenico, R.N., BSN, a professional development manager at Tufts MC, says 100% of cardiac thoracic inpatients have a central line, which demonstrates how important they are to keeping patients alive. Yet the first line of defense against CLABSI is to evaluate each line each day to determine the risk/benefit of its use.

THE SIX KEY STEPS

Tufts MC, like many other hospitals in Massachusetts and throughout the U.S., is basing its improvement efforts on the CUSP: Stop BSI initiative, which uses a "comprehensive unit-based safety program" (CUSP) to stop bloodstream infections. Teams follow a bundle of six steps and then focus on changing the culture of a hospital to address a particular infection problem. Under CUSP, traditional hierarchies are broken down, teamwork is encouraged, and everyone has an equal role in ensuring high-quality, safe patient care.

The basis of the program originated with the Michigan Health & Hospital Association's Keystone Center teaming up with patient safety leaders at Johns Hopkins Medicine to implement the CUSP culture-change model, along with the bundle of proven clinical strategies. The Michigan model had such tremendous success that the Agency for Healthcare Research and Quality funded the Health Research & Educational Trust of the American Hospital Association to expand the program across the country - including Massachusetts where the Massachusetts Hospital Association coordinated the effort.

"Many places throughout the country are doing the same things we're doing - following the same 'bundle' of best practices," says Erik Garpestad, M.D., director of the Medical Intensive Care Unit at Tufts Medical Center "But we found additional best practices, the steps doctors and nurses were taking within their units to achieve better outcomes."

The six main parts of the best-practice bundle are:

Remove unnecessary central lines. Assess the need for a central line every day. Does the patient really need the line? Can other ways of introducing medications be used? And once it's used, how quickly can a central line be removed?
Wash hands prior to inserting central lines. A seemingly obvious step, but one that all hospitals have to stay on top of. Touching one patient, sheet, cup, or pen after your hands are washed means you have to wash your hands again.
Central Line cart. Each area in the hospital has a cart specifically designed with all the items needed for central line insertion. This ensures all items necessary are readily available.
Use maximal barrier precautions during line insertion. That is, don't just cover the neck area if you're inserting a line into the jugular vein; rather, cover the entire body so that if an end of the line flops down during insertion, it doesn't hit the patient's skin but rather lands on a sterile cloth. Barrier precautions also include caps, masks, sterile surgical gowns, and sterile gloves for the operators.
Clean skin with chlorhexidine. It's an antiseptic that simply has proven far more effective than other substances such as rubbing alcohol.
Avoid the femoral site when inserting lines. Of the three places to insert a central line - jugular, subclavical, or femoral - the latter has the potential to be the most unclean and susceptible to soiling. Sometimes, however, it is the only recourse.

Dr. Garpestad says, "We interviewed everyone to see how they maintained the central line, and when we found one practice that was proven to work well, we were able with hospital leadership's encouragement to roll it out in other parts of the hospital."

The best example of how Tufts MC found and disseminated best practice involves the hospital-wide educational roll-out to all providers on how to keep the central lines' "ports" or "hubs" sterilized.

Therese Hudson-Jinks, R.N., MSN, Tufts MC's Chief Nursing Officer and V.P. of patient care services, says, "Whenever we administer fluid or medications through the central line, we 'scrub the hub', meaning we really clean that port in a certain, prescribed way for at least 15 seconds. We don't swipe it with alcohol - we scrub it." In an effort to keep unused ports clean and ready for use, Tufts MC rolled out alcohol swab-caps, which are protective caps that have alcohol soaked gauze inside of them and that are placed on unused ports on central venous catheters. "In a 'small test of change' the alcohol swab-caps were used on two of our high risk floors with notable decreases in CLABSI rates," Hudson-Jinks says. "Now capping as well as scrubbing is standard operating procedure throughout Tufts Medical Center."

Hudson-Jinks says, "We formed a small team to ensure that we weren't just meeting the bundled care goals but that we were also engaging the community on the steps we were taking." Because administrators and others throughout the hospital were involved in the CLABSI-fighting effort, the team had the support to make the changes it needed.

For instance, when it became apparent that the best way to determine if a vein was a good candidate for a central line was to view it with a portable ultrasound machine, hospital administration budgeted for additional ultrasounds so that they could be readily available. Because each nurse involved in central lines had to be trained in new protocols, money for that education effort was found. When the team discovered that the length of the central line may affect infection rates (the shorter the length exposed outside of the patient, the less chance pathogens would use it as a ladder into the body), other units adopted the shorter-lengths, when possible.

The team also determined that having a cart in close proximity to the patient fully loaded with everything needed for an insertion (lines, antiseptic, syringes, gowns and gloves, etc.) eliminated the need for a clinician to leave the room to get a piece of equipment from a supply closet. (If someone leaves the room, they leave the sterile area and increase the chance for infections.)

"If you were to view the insertion of a central line it would look like an operating room," says Susan Murray, R.N., MPH, infection preventionist. "Everyone is gowned and gloved." And one of the first steps in ensuring the cart is placed properly in the patient's room.

Central lines are inserted by M.D.s, but a physician assistant or nurse practitioner can also be certified to perform the procedure. An R.N. is nearby maintaining the checklist and electronically tracking the fulfillment of each step; that nurse monitors the physician and has the authority to enforce a halt if a step is not met. (In very rare instances when a central line is needed ASAP to save the life of a patient, sterile procedures are maintained but the checklist may have to be skipped. "If you don't follow the checklist for whatever reason, the line comes out within 24 hours," Murray says.)

Even the bandaging that covers the central line insertion is applied following a strict procedure.

"We have one way to apply the dressing and R.N.s have to demonstrate competency in that area," says Chief Nurse Hudson-Jinks. "There's a methodology for applying the dressing because you don't want too much of the line exposed and you don't want it pulling away from a patient."

Even though Tufts Medical Center has achieved tremendous success, the core CLABSI-fighting team at the hospital doesn't feel as though it has reached its goal. That's because there is no finish line in the fight against infections. The goal is simply to never waiver from proven strategies for fighting infections, while testing new improvements that come along.

"You have to remain humble," says Dr. Garpestad when discussing Tufts MC's improvement numbers.

Says Murray, "We analyze each time a patient gets an infection, performing a root-cause analysis. Even the way we discuss our work now is different. We don't say, 'We had an infection' but rather 'We have a patient with an infection.' We always keep in mind that it's our patients who are affected by what we do."

Two Hospitals are Co-Winners of Betsy Lehman Patient Safety Award

A Focus on Infection Prevention

Two hospitals within the UMass Memorial Health Care system each received the 2009 Betsy Lehman Patient Safety Recognition Award from the Betsy Lehman Center for Patient Safety and Medical Error Reduction, a program established under the Executive Office of Health and Human Services and housed within the Massachusetts Department of Public Health. UMass Memorial Medical Center and Marlborough Hospital were this year's co-winners.

The 2009 award focused on organizations/healthcare facilities that best demonstrated the promotion of a culture of safety in the reduction of healthcare associated infections. In addition to the primary awards, Certificates of Merit were given to Lahey Clinic's Infection Control Program, Massachusetts General Hospital and the Central Line Infection Reduction Workgroup, and Children's Hospital Boston's Neonatal Intensive Care Unit.

The Betsy Lehman Patient Safety Recognition Award was established in 2005 to recognize leadership and innovation in patient safety including public awareness, education and promotion of systems-based solutions through the implementation of best practices.

Marlborough Hospital's Achievement

At Marlborough Hospital, an interdisciplinary task force of physicians, nurses, managers, and members of the quality, infection control and radiology departments worked diligently evaluating processes, policies and equipment to integrate a series of health care "best practices" to completely eliminate central line blood stream infections in hospitalized patients. For the past 13 months, there were no central line infections at the hospital. The hospital also adopted innovative programs to ensure high levels of performance in critical efforts such as increasing hand hygiene compliance, improving inpatient pneumococcal and influenza vaccination rates, and distribution of appropriate antibiotics to prevent pneumonia in intensive care unit patients.

"We are honored to receive the distinguished Betsy Lehman award," said John Polanowicz, CEO and president of Marlborough Hospital. "We are a community hospital where many talented, highly skilled and compassionate clinical leaders are committed to outstanding quality and safety outcomes for our patients. I thank everyone for their great work and know this will propel us forward to even greater achievements."

UMass Memorial Medical Center's Achievement

UMass Memorial Medical Center's award was presented in recognition of the Division of Cardiac Surgery's accomplishments in building a culture of safety, reducing health care associated infections, enhancing data monitoring resulting in implementation of evidence-based best practices, and focusing on innovative system-based solutions to support ongoing improvement in quality and patient safety. The division has consistently demonstrated lower mortality and infection rates than the state average, and has maintained zero percent incidences of postoperative mediastinitis, a life-threatening health care-associated infection, since 2007.

"By focusing on safety, data and communication, we have established a vision of zero tolerance to any outcome that does not put patient safety first," said Stanley Tam, MD, chief of Cardiothoracic Surgery at UMass Memorial Medical Center.

"Our cardiac surgery team has been recognized as one of the best in the nation and our whole Medical Center continues to set the bar for excellence in quality outcomes and patient safety," said Walter Ettinger, MD, MBA, president of UMass Memorial Medical Center.

This year marks the first occasion that the primary award winners were members of the same health care system. "We are extremely proud to be recognized by the Betsy Lehman Center," said John O'Brien, president and CEO of UMass Memorial Health Care. "Improving quality, safety and the patient experience is paramount throughout the hospitals and physician practices of our system. I thank and congratulate everyone associated with these programs which make such a positive impact to our patients."

About the Betsy Lehman Center

The Betsy Lehman Center was formed in 2002, with the goal of improving patient safety and reducing medical errors through coordinating state agency initiatives, promoting ongoing collaboration between the public and private sectors, coordinating state and federal safety programs, and promoting patient safety through educating both health care providers and patients. The center is named for Betsy Lehman, a Boston Globe reporter who died in 1994 as the result of a chemotherapy overdose. Go to www.mass.gov/dph/betsylehman for more information.

###

UMass Memorial Diabetes Scorecard

Tool used to help engage patients in their own care.

One of the biggest challenges with managing diabetes is motivating patients to take an appropriately active role in their health. To help meet this challenge, UMass Memorial Medical Center has launched a pilot program to test an innovative diabetes management "scorecard."

The scorecard contains the patient's diabetes-related health information obtained through UMass Memorial's electronic medical record system. It is presented in an easy-to-comprehend graphical format and is printed prior to each patient's visit so it can be handed to them during the check in process. Together, the doctor and the patient can then review its contents and discuss goals they hope to achieve regarding health measures specific to that patient's diabetes.

Read the full story here.

Winchester Hospital — Reducing IV-associated bloodstream infection

Executive Treatment Urged to Drive Down Infection Rates

By Jane Sherwin

Culture change requires top leadership to get engaged, collaborate with staff

Reducing catheter-related bloodstream infections remains a challenge for many hospitals. In a recent survey by the Association for Professionals in Infection Control and Epidemiology, 40 percent of respondents said their hospitals had been targeting CRBSI reduction for up to 10 years, but nearly half said CRBSI's are at least somewhat problematic at their facility and fewer than one in five reported zero infections.

Hospitals that have reduced their CRBSI rates to zero or near-zero use a straightforward five-step checklist developed by the Michigan Health & Hospital Association and Johns Hopkins University. The Hopkins checklist, as it is commonly referred to now, includes simple steps such as hand washing by all staff, but usually calls for a cultural shift toward greater equality among team members. And that requires executive commitment.

"To succeed in using the checklist, senior management needs to get visibly involved," says Gina Pugliese, R.N., vice president of the Premier Safety Institute. Pugliese suggests making scheduled rounds to the front lines to observe and offer support to staff as needed, especially in cases where physicians may resist the new process. In-house publicity is also important.

Kay Deackoff, infection prevention specialist at Winchester Hospital in Massachusetts, says the hospital went 37 months without a single ICU IV-associated bloodstream infection. "CRBSI reduction is discussed regularly at all leadership meetings and findings are cascaded to the staff level," she says. "Leaders and staff alike are empowered to make changes and implement strategies whenever appropriate for improved patient care."

South Carolina's Georgetown Hospital System reduced catheter-related infections by about five cases annually to near zero. Roy Gilbreath, M.D., vice president of medical affairs, says that CRBSI rates are followed monthly by both the hospital board and the quality council. The board delegated CRBSI reduction oversight to its harm-reduction committee.

Most implementation costs are for redesigning a process: meetings, training and monitoring for compliance, Pugliese says. Costs will vary with the size and complexity of the hospital. Gilbreath estimates Georgetown's first-year equipment expenditures at about $20,000, with half of that recurring yearly, compared with an industry estimated average cost of $30,000 per case.

The American Hospital Association is working with state associations and collaborative groups to support hospitals in CRBSI reduction. Nancy Foster, the AHA's vice president for quality and patient safety, points to the On the CUSP: Stop BSI initiative led by the Health Research and Educational Trust. HRET recently announced the availability of $5.8 million to support CUSP participants. The funds are part of an Agency for Healthcare Research and Quality grant that HRET administers.

This article 1st appeared in the September 2010 issue of HHN Magazine.

Winchester Hospital’s Hand-Hygiene Competency

An estimated 85 percent of hospital-acquired infections are due to organisms carried on the hands of personnel. As a result, Winchester Hospital has launched a hospital-wide hand hygiene competency for all employees in an effort to save patients from avoidable harm.

The competency includes reciting three opportunities for hand hygiene, communicating three infection prevention strategies (staying home if you are ill, coughing or sneezing into your elbow or sleeve, and hand hygiene), and demonstrating proper hand hygiene technique with either soap and water or alcohol-based hand gel.

To kick off the competency assessment, the hospital's senior management team had their hand hygiene practices reviewed by Pam Linzer, infection prevention specialist at Winchester Hospital. Every employee's hand hygiene competency is being assessed in their department and evaluated by a champion of Winchester Hospital's Environment of Safety Committee, a Nursing Quality Council representative, or an infection prevention champion selected within their department.

Last year, Winchester Hospital's Medical/Infectious Diseases Unit Performance Improvement Team set a goal to reduce all hospital-acquired infections due to multidrug resistant organisms (MRSA, CDIFF, VRE, or ESBL) by 50 percent (eight or more cases). Whereas 21 percent of unit employees were observed complying with hand hygiene in December 2008, the unit reached 100 percent compliance by March 2009. The monthly statistics have not fallen below 85 percent since that time.

The team achieved this goal through employee feedback, which suggested adding more Purell dispensers, making the dispensers more visible, adding wipe holders to the unit, and posting flyers about the importance of hand hygiene.
The second phase of the process, which began in April 2009, focused on the isolate practices and compliance. That month, employees of the Medical/Infectious Diseases Unit were observed complying with the use of gowns and gloves when entering a marked isolation room 50 percent of the time. Four months later, compliance had soared to 80 percent. The program is being rolled out to other units in the hospital.

Thanks to the great efforts of this team, Winchester Hospital has become a safer place for our patients and employees.

Winchester Hospital: A Focus on Outcomes

Like all hospitals, Winchester Hospital has its share of preventable harm events and, like all hospitals, it is constantly striving to improve. In 2008, Winchester Hospital experienced 108 preventable harm events in five categories: serious medication errors; surgical site infections; ventilator-associated pneumonia; falls with serious injury; and central line-associated bloodstream infections. At the close of 2010, this number had dropped to four. The goal for 2011 is zero. Winchester's passion for improvement inspired leaders at the Institute for Healthcare Improvement (IHI) to invite hospital leaders and staff to share these results at an international webinar. A team of health care leaders from Denmark that participated in the webinar subsequently sent staff members to visit Winchester Hospital to learn first-hand from our performance improvement efforts.

This article details some of Winchester Hospital's remarkable achievements.

Winchester’s Hospital to Home Care for Joint Replacement Patients

Hospital to Home Care for Elective Joint Replacement Patients

Providing high-quality post-acute care to patients recovering from an illness or injury is a critical component of the healthcare delivery system. The Medicare fee-for-service payment method has historically limited the incentive to promote integrated post-acute care where providers work together to determine the most appropriate and cost-effective care setting and then collaborate to achieve a smooth care transition.

However, a partnership between the Winchester Hospital Joint Program, Excel Orthopedics, and Winchester Home Care via a private health information exchange is changing that. Winchester Home Care is taking on reform of the current system with an integrated post-acute care management model for patients who undergo elective joint replacements.

The program was launched in 2013 with the intent of:

Breaking down post-acute care silos, and replacing them with a collaborative approach around identifying which patients are appropriate for each post-acute care setting.
Reducing rehabilitation stays and increasing the rate of discharges to home after elective joint replacement surgery.
Creating a post-acute care system that is more patient centered and that reduces the need for emergent care and rehospitalization.

An initial team identified technology (including a mechanism to communicate patient information via a secure system) and education (of all parties, including the patient) as central to the project's success.

The project launch was aided by a grant of $75,000 from The Massachusetts eHealth Institute that supported efforts to improve communication and enhance the efficiency of workflow between the orthopedic practice, pre-admission testing, and home care. In the planning phase of the eHealth project implementation, the home care team worked to begin the shift towards enabling more patients to go directly home from their surgical inpatient stay. The Mass HIway was used beginning in May 2014 and provided a seamless approach to communicating information, eliminating the manual processes set up during the implementation phase.

Critical to the effort was the identification of patients who are appropriate for discharge directly home versus a transfer to a skilled nursing facility. One of the mechanisms used to determine this for some patients is RAPT (Risk Assessment and Prediction Tool), developed by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation. This tool helps determine whether a patient is a suitable candidate for an integrated program, which enables the patient to be discharged from a hospital directly to their home.

In addition, the use of a secure electronic communication system triggers a process by which an increased number of patients are enrolled in Winchester Hospital pre-surgical education (Joint Class). By increasing the number of participants in this Joint Class, patients are better educated on their options for post-acute care, with an emphasis on the option of going directly home with services after their inpatient stay. The added feature of having this secure electronic communication is that upon discharge from home care, certain clinical documents can be sent to the orthopedic office, allowing the surgeon to review the patient's progress with recovery.

The team was able to shift significantly the percentage of patients who were discharged home from their surgical inpatient stay versus discharge to a skilled rehab facility. This shift began during the planning phase for the Mass HIway implementation project and, to date, reflects a 30% increase in these patients receiving their post-surgical care at home.

According to Karen Keaney, director of Winchester Home Care, "This program has resulted in a significant increase in patients' electing to receive their post-hospitalization services in the home care setting as compared to a rehabilitation facility. Our patients have benefited from the partnership between the orthopedic practice, hospital, and home care as evidenced by excellent clinical outcomes, and, most notably, a zero readmission rate for patients admitted directly to home care from inpatient surgical hospitalization."

The Conversation Project

The Conversation Project is dedicated to helping people talk about their wishes for end-of-life care.
Too many people are dying in a way they wouldn’t choose, and too many of their loved ones are left feeling bereaved, guilty, and uncertain.

It’s time to transform our culture so we shift from not talking about dying to talking about it. It’s time to share the way we want to live at the end of our lives. And it’s time to communicate about the kind of care we want and don’t want for ourselves.

We believe that the place for this to begin is at the kitchen table—not in the intensive care unit—with the people we love, before it’s too late.

Together we can make these difficult conversations easier. We can make sure that our own wishes and those of our loved ones are expressed and respected.
Read more…

The Conversation Starter Kit

It’s not easy to talk about how you want the end of your life to be. But it’s one of the most important conversations you can have with your loved ones.

This Starter Kit will help you get your thoughts together and then have the conversation. This isn’t about filling out Advance Directives or other medical forms. It’s about talking to your loved ones about what you or they want for end-of-life care.

Whether you’re getting ready to tell someone what you want, or you want to help someone else get ready to talk, we hope the Starter Kit will be a useful guide. We want you to be the expert on your wishes and those of your loved ones. Not the doctors or nurses.