Reports point out hot spots in paths
Detailed data come from variance tracking
Process improvement teams at Dominican Santa Cruz (CA) Hospital receive monthly reports that identify "hot spots" on clinical paths in use at the 380-bed facility.
The teams, in conjunction with an outcomes manager, are able to identify specific problems because the monthly report analyzes detailed variance data collected from the hospital's 35 clinical paths, says Lynda Stratton, RN, outcomes manager at Dominican Santa Cruz.
Variance data are documented by staff on a multidisciplinary problem identification and documentation record that allows outcomes managers to "drill down to a particular problem," explains Stratton.
"We can see, for example, that 80% of the total hip patients didn't receive physical therapy on day two. We can then see the breakdown on the reasons, such as the patient was too sick or therapy was not available," adds Stratton.
Providing detailed monthly reports to pathway improvement teams also benefits the hospital's utilization review (UR) nurses, notes Stratton. "We don't have case managers. Instead, the UR nurse does concurrent reviews of the patient's path and often documents the variances. As a result, they see that we're not just collecting and storing data. They see what the information means."
The monthly reports compile information on data indicators matching interventions or outcomes from a clinical pathway. For example, the pathway management report for total joint replacement includes 40 data indicators.
Data indicators are broken down in a spreadsheet format for yearly and monthly totals. Indicator categories and subcategories for the total joint replacement report, for example, include the following:
* pathway utilization:
-- cases on pathway;
-- patient within pathway length of stay (LOS);
-- average number of variances per pathway case.
* patient demographics:
-- average age.
* financial:
-- discharged to home;
-- discharged to home health;
-- discharged to rehabilitation/skilled nursing facility;
-- average hospital LOS;
-- readmits within 30 days;
-- average cost per pathway case.
* clinical interventions and outcomes:
-- mortality during hospitalization;
-- did not receive antibiotic pre-op in operating room;
-- did not tolerate physical activity post-op day one;
-- did not have anti-thrombotic started by post-op day one;
-- epidural not discontinued at 72 hours;
-- no discharge plan by post-op day three.
* customer satisfaction:
-- percentage of patients and family members who attend the joint replacement class.
* functional health assessment:
-- physical functioning;
-- role physical;
-- pain;
-- mental health;
-- role emotional;
-- social function;
-- energy;
-- general health perception;
-- percentage of males;
-- percentage of females;
-- percentage married;
-- race;
-- percentage with chronic lung disease;
-- percentage with blindness;
-- percentage with deafness;
-- percentage with sugar diabetes;
-- percentage with asthma;
-- percentage with ulcer or gastrointestinal bleeding;
-- percentage with history of arthritis or rheumatism;
-- percentage with sciatica or chronic back problems;
-- percentage with hypertension;
-- percentage with angina;
-- percentage with cancer.
Data are entered into the hospital's internal database -- which was developed by a physician and a colleague -- by a dedicated staff member following a patient's discharge. Quarterly reports are distributed to physicians with individual and group comparisons, adds Stratton. *
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