1. Box 5: Solution Approach
RESULTS
Box 1: Reason For Action
Box 8: Confirmed State
ANALYSIS AND NEXT STEPS:
Multidisciplinary rounds have led to a decrease in Excess Days and
Medicare ALOS at PMMC. Standard work , best practices, and
lessons learned are being shared with PSJHE. Next steps include
the following:
• Continue to hardwire the process at PMMC and collect real-time
reasons for excess days (MDI)
• Spread the process to all inpatient units at PMMC M-F
• Observe PSJHE process and coach for more consistency &
participation
• Work to include patient and family in multidisciplinary rounds
Acknowledgements
Executive Sponsor: Grace McBride
Process Owners: Vanessa Hiland, Roxann Barber
Team Members: Peg Lagrassa, Sally Sanchez, Rex King, Larry
Lillwitz, Elsa Huedem, Gina Wilderspin, Diane Romito, David Lee
BTI Facilitators: Jason Egan, Omar Ordaz, Kelsey Knutti
We are not effectively utilizing the
professional expertise and knowledge of a
multidisciplinary team in a collaborative
coordinated fashion to optimize clinical
outcomes in an effective manner. This can
result in excess days.
In Scope: Patients managed by hospitalist
services at PMMC
Trigger: Patient admitted to hospitalist group
Done: Transition to next level of appropriate
care
Box 2: Initial State
Improving Length of Stay Through
Multidisciplinary Rounds
Box 3: Target State
If We Did This…
Then We Would Expect These
Results…
If we had physician
involvement in Multi-
Disciplinary Rounds…
...Then we would have immediate
action taken on pending items.
If we were to enhance the
whiteboard to include
multiple disciplines…
...Then we would expect a complete
picture of patient needs and a
standard communication process.
If we were to standardize
the current process of rounds…
...Then we would have a more
uniform process for rounds and
future roll out to other units
Initial State Characteristics:
• De-centralized patient information
• Lack of staff buy-in & engagement
• Lack of patient involvement
• Lack of ownership of process
Target State Characteristics:
• Patient & family participation
• Standard, visible information sharing
• Consistent plan of care information
communicated across all disciplines
0.0
1.0
2.0
3.0
4.0
5.0
6.0
Jan '14 Feb '14 Mar '14 Apr '14 May '14 Jun '14 Jul '14 Aug '14 Sep '14 Oct '14 Nov '14 Dec '14 Jan '15 Feb '15 Mar '15 Apr '15 May '15 Jun '15 Jul '15 Aug '15
Days
PMMC Medicare ALOS
Jan '14 - Aug '15
0
1
2
3
4
5
6
7
Jan '14 Feb '14 Mar '14 Apr '14 May '14 Jun '14 Jul '14 Aug '14
PMMC Medicare ALOS
Jan '14 - Aug '14
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
55%
Jan '14 Feb '14 Mar '14 Apr '14 May '14 Jun '14 Jul '14 Aug '14 Sep '14 Oct '14 Nov '14 Dec '14 Jan '15 Feb '15 Mar '15 Apr '15 May '15 Jun '15 Jul '15 Aug '15
PMMC Excess Days and Failure Rate -
Medicare Patients Jan ‘14 – Aug ‘15
Excess Days % of Total Days Failure Rate
Domain Metric Base Target 2015 Trend
People
Pre-Implementation Satisfaction
Survey
3.95 / 5 4.5 / 5 4.57 / 5
Service Medicare LOS 4.7 days 4.4 4.3 (YTD)
Service
HCAHPS score - MD Explain
percentile
80% 89% 86% (Q3)
Quality
HCAHPS score - RN Explain
percentile
72% 86% 83% (Q3)
Disciplines Involved:
• Hospitalists
• Nursing
• Care Management
• Therapies
• Nutrition
• Clinical Documentation
• Pastoral Care
• Pharmacy
Standard Discussion Points:
• Introduction of patient
• Medical care plan
summary
• Patient / Family concerns
• LOS, GMLOS, and
variances
• Discharge needs / barriers
• Medication issues,
alternatives
• Other disciplinary issues,
barriers, needs
Domain Metric Baseline Target
People
Pre-Implementation Satifaction
Survey
3.95 / 5 4.5 / 5
Service Medicare LOS 4.7 4.4
Service HCAHPS score - MD Explain percentile 80% 89%
Service HCAHPS score - RN Explain percentile 72% 86%