Abbott Northwestern Hospital: VBP

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Table of Contents

Section A1
Department A
Department B
Department C
Section B5
Section B7
Abbott Northwestern Hospital: Executive Summary
References

Section A1

VBP is essential for improving health care services and staff performance. Abbott Northwestern Hospital in Minneapolis has already experienced its advantages. As an acute care hospital, Abbott Northwestern Hospital is eligible for the Hospital VBP Program. So far, the hospital has sufficiently embraced VBP in the domains of patient safety and patient and caregiver-centered experience of care. Particularly, such a significant patient outcomes factor as communication with the hospital’s medical professionals was considerably improved. The organization has consistently high staff responsiveness, doctor communication, and nurse communication indicators. Nonetheless, some other VBP aspects seem to lack. Overall, Abbott Northwestern Hospital seems to rely on the VBP standards of hospital performance to an adequate extent.

Department A

B1. The emergency departmentfunctions as a gatekeeper and a hub. ED often faces the need to contain costs while increasing quality (Von Eiff & Von Eiff, 2016). Thus, the department is essential for implementing VBP’s standards of efficiency and cost reduction.

B2. Optimize the ER patient flow within the next three years. ED overcrowding not only substantially worsens patient experience but possibly impacts health outcomes by delaying the time of treatment (Salway et al., 2017). In addition, ED crowding is expensive – it causes preventable expenditures. Optimizing ER patient flow would enhance the hospital’s efficiency and reduce costs.

B3.

Measure the performance of the hospital’s patient flow team and turnaround time (TAT) to identify areas needing improvement.
Innovate the department by implementing point-of-care testing (POCT).
Accelerate TAT for lab results.

Increase the effectiveness of intradepartmental communication for improved patient flow and patient satisfaction.
Re-examine record-keeping practices to maximize interdepartmental communication.
Improve the quality of discharge information by complimenting the written emergency department discharge instructions with pre-printed information sheets.

B4. Key Points:

Reflect on the causes of communication breakdowns in the ED.
Implement more detailed record keeping.
Ensure the quality and that all the necessary information is included in discharge sheets.
Practice effective communication with colleagues.

B4a

Create a PowerPoint presentation on the methods of effective communication within a healthcare setting and test how the ED staff retained information afterward.
Familiarize and explain to the ED staff the new discharge information practice during a staff meeting.
Create and ask the employees to fill in a form regarding how they think communication can be improved.

Introduce the pre-printed discharge information sheets idea.
Explain its benefits for patients’ knowledge of post-discharge care and treatment adherence.
Answer the following questions.
Assign the responsible person for creating the pre-printed information shits.

Explain the notion of effective communication and related ones.
Identify problems and brainstorm solutions.
Role-play effective communication scenarios.
Finish with collectively creating effective communication in ED guidelines.

Department B

B1. The role of the surgical departmentin maximizing the hospital’s safety and clinical care cannot be overestimated. Surgical site infections (SSI) after abdominal hysterectomy account for a sizeable part of hospital readmissions (Napolitano et al., 2017). The problem is persistent even in developed countries (Napolitano et al., 2017). SSI increases the hospital’s morbidity and median length of stay, extremely important aspects of VBP.
B2. The goal is to reduce the incidence of SSI after abdominal hysterectomy via evidence-based prevention practices within three years. Reducing SSI incidence would decrease the hospital’s morbidity rate as well as other crucial indicators of care quality (Blumberg et al., 2018). It is essential to establish that SSI incidence tangibly impacts an organization’s safety scores and, consequently, reimbursement.
B3. Re-educate staff about patient preparation before abdominal hysterectomy, including preoperative washing with antiseptic soap. Increase the quality of post-operative patient education regarding wound care. Ensure adherence to CDC infection control guidelines. Develop teamwork and collaborative care for decreasing SSI incidence.	Identify the patient group of higher risk of readmission. Engage ESL or non-English speaking patients and those with increased BMI in in-depth, individualized post-operative patient education. Create a Spanish version of printed post-operative patient education information sheets.
B4. Regularly revise CDC guidelines for the prevention of surgical site infection. Research methods to optimize patient preparation before surgery. Create a pamphlet to improve post-operative patient education regarding home incision care. Following the points should allow for lowering the readmission resulting from SSI after abdominal hysterectomy. Decreasing SSI incidence is one of the VBP key measures.
B4a. Conduct a meeting to discuss preoperative patient preparation practices and convey the significance of preoperative washing with antiseptic soap. Distribute printed SSI fact sheets to ensure the understanding of the problem’s seriousness. Email the SSI prevention guideline and test the surgical team’s knowledge using a Google form.
B6. Emphasize the role of SSI in VBP reimbursement. State the meeting’s objectives. Distribute printed SSI fact sheets among surgical department staff. Respond to the SSI fact sheet-related and other questions.	Outline the need to improve preoperative patient preparation practices. Ask the medical professionals to present information about abdominal hysterectomy and patient preparation that they should have researched before. Discuss the practices and the new information introduced. Amalgamate the ideas and form a list of peculiarities of pre-abdominal hysterectomy patient preparation.

Department C

B1. The outpatient departmentis significant for early diagnosis and preventive care. The quality of doctor-patient communication influences patient safety, particularly regarding medications.
B2.The primary goal in OPD is to improve the quality of communication about new medicines to preventavoidable admissions and increase HCAHPS scores overall. High-quality physician-patient communication is remarkably significant when new medicines are prescribed since patients commonly misinterpret or experience difficulties with medication labels(Klingbeil & Gibson, 2018).
B3. Cultivate an individual approach to the prescription of new medicines. Compel and teach OPD physicians to use the teach-back method in communication with patients. Follow-up with post-visit phone calls to enhance adherence to treatment.	Enhance the patient experience as the interactions will be more personalized. Reduce avoidable hospital admission rate. Increase further the hospital’sHCAHPS scores based on improved doctor-patient communication.
B4. Implement the teach-back method in communication with patients about newly prescribed medicines. Consider patients’ peculiarities when talking about new medicines, such as a patient’s level of English. Rely on follow-up calls for ensuring that patients correctly administer their medication and adhere to treatment. The key points are supposed to decrease the rate of avoidable admissions and thus improve VBP scores.
B4a. Organize a seminar about teach-back and other mnemonic techniques. Notify the OPD staff about the introduction of the mandatory follow-up calls during a meeting. Conduct a training session about an individualized approach to patient-doctor communication.
B6. Establish the idea ofmandatory follow-up calls. State the need to incorporate it into the department’s practice. Analyze how follow-up calls can benefit the OPD.	Introduce the teach-back method. Give background information. Outlines the method’s benefits and value for improving VBP scores. Conclude the seminar with a discussion regarding the application of mnemonics.

Section B5

Clinical practice is abundant with complex ethical dilemmas. One such possible dilemma is the necessity to respect a patient’s health care decisions in contrast to the need to act to their benefit. Particularly, this is evident in cross-cultural care when a patient’s cultural background impacts the health care provision (Pereda & Montoya, 2018).

Nevertheless, without the cultural component in care, the principle of benefice cannot be respected since acting in a patient’s best interests requires considering their views on death, life, and health (Pereda & Montoya, 2018). For instance, in ICU, a patient’s family may ask for comfort care and pain relief instead of aggressive interventions that a health care provider believes to be indispensable. The connection between cross-cultural and ethical care becomes particularly considerable in such a highly diversified country as the United States. Therefore, the strategic plan will contain a component of cultural competence.

Clinical practice is not invulnerable to unethical business, possibly to a higher degree in for-profit hospitals. For example, prescribing redundant or unrequited medical procedures and medicines can be considered an unethical business practice. Firstly, redundant prescribing indicates the unsatisfactory quality of a medical professional’s prescribing practices. Secondly, such a situation compromises the principles of honesty, integrity, and respect for others found in ethical business (Tracy, 2016).

It contradicts the principle of fidelity used in medical ethics, potentially diminishing the community’s trust. Additionally, the prescription of redundant drugs can result in adverse outcomes following polypharmacy (Payne, 2020). To avoid similar situations, in the strategic plan, the principles of business ethics and the principle of fidelity will be emphasized to limit redundant prescribing. The strategic plan will incorporate the requirement to prescribe only essential procedures and medicines.

Section B7

Time Increments	Emergency Department	Surgical Department	Outpatient Department
0-4 months	Estimate the ED patient flow management. Establish the causes of patient crowding. Reconsider and refine the chosen strategies.	Establish the hospital’s SSI incidence. Investigate the SSI risk factors. Research further SSI reduction and prevention.	Evaluate the current prescribing practices. Investigate patients’ feedback on the communication about medicines.
4-8 months	Start preparing PowerPoint presentation, pre-printed discharge instructions, and other materials. Research Point-Of-Care-Testing Certificate Course. Increase TAT by optimizing work processes.	Develop the materials to be used in training. Conduct a meeting with the surgical nurses to introduce the idea.	Contact Outpatient Services Manager. Start preparing materials for online and face-to-face educational sessions.
8-27 months	Staff meetings on the new discharge information practices. Effective communication in ED training sessions. POCT training.	Preoperative patient preparation seminars. SSI informative meetings. Distribute CDC guidelines.	Training sessions regarding prescription practices and mnemonic methods. Informative meetings on mandatory follow-up calls.
28-36 months	Calculate and compare the previous and new TAT results. Conduct a survey among ED staff. Evaluate changes in patients’ feedback.	Compare the SSI incidence after abdominal hysterectomy rates before and after the training. Investigate the effect on the department’s readmission and length of stay.	Research patients’ feedback on communication about medicines after the training. Conduct a survey to determine whether patients have fewer difficulties with medication labels.

Abbott Northwestern Hospital: Executive Summary

VBP can be a considerable source of reimbursement for Abbott Northwestern Hospital. Therefore, it is important for the organization to develop and improve according to the program’s standards. The three areas for improvement are ED patient flow, SSI after abdominal hysterectomy, and the quality of prescription practices. Firstly, improving ED is essential for HCAHPS: crowding in this department can worsen patient experience and their satisfaction from a visit. Moreover, crowding delays the treatment, which can have detrimental consequences for health. In many cases, ED is the first department that a patient sees and therefore bases their judgment about the whole organization on their experience in it. An optimized patient flow could help minimize crowding and increase patient satisfaction.

Secondly, high SSI incidence after abdominal hysterectomy signals the low quality of work performed in a surgical department. Reducing its occurrence in Abbott Northwestern Hospital would show a higher quality of care. In VBP, SSI is associated with the domain of patient safety. Lowering SSI incidence could also positively correlate with decreased length of stay, readmissions, and overall morbidity. Thirdly, the doctor-patient communication and communication about medicines in OPT influences HCAHPS. Refined communication helps patients adhere to treatment, and administer their medicines correctly, positively influencing their safety. High-quality physician-patient communication about newly prescribed drugs is essential for gaining community trust.

ER improvement primarily involves forming and perfecting a patient flow team. In order to promote effective communication, the team’s members will undergo intradepartmental training. Nevertheless, other clinicians of the department should also participate to maximize the results. In the course of the program, with the help of consultants, ED staff will refine their existing communication skill set that will allow them to operate more efficiently in a stressful medical setting. Some ED health professionals will also participate in the Point-Of-Care-Testing Certificate Course to ensure the appropriate use of technology. Constant performance evaluation will be performed through the later phases to validate the training’s effectiveness in improving patient flow.

For the surgical department initiative, nurses will play a significant role due to their function in preoperative patient preparation. The head nurse will be contacted and asked to supervise the deployment of the initiative. Surgical nurses headed by the head nurse will complete training designed to re-educate the medical specialists regarding preoperative patient preparation for abdominal hysterectomy according to CDC guidelines. Once coaching is finished, the surgical nurses will create a post-operative care information sheet to finalize their training. Also, a specialist will be employed to adapt it for ESL patients. Post-operative patient education is the initiative’s other element.

For the OPD, Outpatient Services Manager will head the initiative and oversee the staff’s adherence to the plan. They will notify the OPD physicians and facilitate estimating their performance. The OPD physicians will participate in seminars and training sessions about redundant prescribing, doctor-patient communication about medicines, managing polypharmacy, and use of the teach-back mnemonic method. Some of the activities will be effectuated online, while others will necessitate face-to-face learning, for instance, role-playing exercises. By the end of the training, the medical professionals are supposed to increase the quality of their prescribing practices. The initiative’s success will be evaluated based on changes in HCAHPS.

References

Blumberg, T. J., Woelber, E., Bellabarba, C., Bransford, R., & Spina, N. (2018). Predictors of increased cost and length of stay in the treatment of post-operative spine surgical site infection. The Spine Journal, 18(2), 300–306.

Klingbeil, C., & Gibson, C. (2018). The teach-back project: A system-wide evidence-based practice implementation. Journal of Pediatric Nursing, 42, 81–85.

Napolitano, F., Tomassoni, D., Cascone, D., Di Giuseppe, G., di Mauro, M., & Rago, V. (2017). Evaluation of hospital readmissions for surgical site infections in Italy. European Journal of Public Health, 28(3), 421–425.

Payne, R. A. (2020). Polypharmacy and deprescribing. Medicine, 48(7), 468-471.

Pereda, B., & Montoya, M. (2018). Addressing Implicit Bias to Improve Cross-cultural Care. Clinical Obstetrics and Gynecology, 61, 2-9.

Salway, R., Valenzuela, R., Shoenberger, J., Mallon, W., & Viccellio, A. (2017). Emergency department (ed) overcrowding: Evidence-based answers to frequently asked questions. Revista Médica Clínica Las Condes, 28(2), 213–219.

Tracy, B. (2016). The importance of honesty and integrity in Business. Entrepreneur. Web.

Von Eiff, M. C., & Von Eiff, W. (2016). Role and function of the emergency department in a boundaryless hospital: Optimizing the process flow. Boundaryless Hospital, 211–234.

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