It is truly an honor to represent the Hartford HealthCare Digestive Health Institute and share our process in improvement initiative. This is my disclosed statement. My discussion point would be the process improvement for outpatient readmission, which includes the target population, quality improvement project drivers, and the model of improvement that was used. I will also discuss the initial process of capturing the readmission notification and metrics from one of our Hartford HealthCare endoscopy sites and the changes we implemented after analyzing the data from the initial readmission process. Finally, based on the data, I will also present one of the implementations we are working on to reduce the readmission rate. Next week, one of our endoscopy sites will be going live with this implementation. What is a QI project? QI refers to a structured initiative within an organization that aims to identify and resolve issues within the current process. So the main objective of a quality improvement project is to achieve measurable enhancement in the quality of readmission outcomes. In Hartford HealthCare, capturing readmission within two weeks post-procedure was a long project that went live in January 2024. In our QI project, we define readmission as a patient who returns to the emergency department or if they get admitted within two weeks post-procedure. Our target population consists of outpatients who have recently undergone an endoscopy procedure. The drivers for this project were because of lack of monitoring systems for hospitals readmission after outpatient endoscopy procedure and absence of system or report for tracking outpatient readmission. As a result, we were unable to identify areas needing improvement in readmission rate. And also, we did not have a standardized M&M process and also, an easy way to collect OP32, which is a facility seven days with standardized hospital visit outpatient endoscopy. When DO-STUDY-X PDFA cycle was used as a model of improvement to guide our QI project. The primary aim for this QI was to identify the root cause of frequent hospital readmission, reduce the readmission rate, identify the factors that contributed to the readmission, determine the timeframe for patient readmission, and total readmission. The end goal is to reduce the readmission rate. In January, 2024, we successfully launched real-time readmission notification system with the objective of understanding the readmission process measures and analyzing the readmission data. Our findings revealed that changes were required. Many of the readmission notification we received were found to be outside the scope. For one example, a patient who was already admitted as an inpatient and underwent a procedure and then returned to their room was getting flagged as readmission. We made corrective changes to the notification system to only include readmission for post-outpatient endoscopy procedures. This change was challenging for the IT team, but we were able to make the changes to only include outpatient post-endoscopy readmission. In the initial readmission project, the quality RN was the only person who was receiving the real-time readmission notification from EPIC, which I will forward the notification to the site manager. This decision was made because it would be easier to track since we have nine hospitals and giving access directly to all the sites would have been more challenging. When the nurse managers received the notification, they will complete the intake form in the RADCAP survey, which contains patient demographics. During this time, the nurse manager will review the patient's chart, and if the procedure is unrelated, no further action will be required. Once the intake form is completed, I will receive the notification, and I will close the survey in RADCAP. If the manager reviews the case and determines that the readmission is directly, indirectly, or probably related to the procedure, the manager will discuss the case with the GI endoscopy director. And during this time, the GI endoscopy director will decide if the case should be presented at the GI division MNM meeting or not. If the case is not presented, the nurse manager will complete the second part of the survey based on the decision made by the GI endoscopy director. And if the case is selected to be presented, the nurse manager will complete the second part of the survey questions during the GI division MNM. Once the second part of the survey is completed, I will receive the notification via email, and during this time, I'll review and close the RADCAP survey. In the following slide, I will discuss what is included in the second part of the survey. The initial process was monitored for several months. I was the only staff who was getting the real-time notification, and this was to help monitor and making sure the trigger was getting triggered correctly. And with this, we updated the readmission process. The newly updated process remained largely the same, but now each site manager and one other RN who will be the backup for the manager will receive the real-time notification instead of GI quality on it. The method we used for the QI readmission project involved APIC, which is the real-time notification, RADCAP for collecting and tracking readmission through an online survey, and also Tableau as a visual dashboard. The real-time notification in APIC provides important details about patient returning to the emergency department, which includes the date of their visit to the ED, hospital ED location they went to, patient name, medical record number, and patient age. We also included an insurance coverage, which is patient payer information to help collect OP32 for CMS. In addition, we also have a column that provides acknowledge notification. If the nurse opens the patient's chart, it will mark as RADCAP, and if no one has opened it, it will remain as RADCAP. We used the RADCAP survey, which is a secure web application to manage all the advanced period admissions. This survey helps us collect all the readmissions, where the first page of the survey consists of patient demographics. The PowerPoint is showing the breakdown of the second part of the survey in RADCAP, which is completed if the admission is either directly or indirectly related to the procedure. This survey covers six categories. Classification, that includes the agreed classification, which is used as a standardized method for evaluating adverse events. Complications, root cause of the complication, events, action plan, and referral. I have also created a Tableau dashboard for my own use, and I'm currently seeking approval to develop a readmission dashboard for the system. This dashboard will allow all the regional quality directors, managers, VP, and other leaders to see the trend of the readmission, which also will serve as a valuable dashboard by providing information, such as timing of the patient return, payer information, details by providers, and other readmission data. I have a poll question. The first poll question is, does your endoscopy unit monitor outpatient endoscopy and readmissions? A, yes. B, no. C, in the process of implementing. D, I'm not sure. Thank you for your response. The majority of the response for the poll question answers A, yes. This is 2024 data from one of the Harper Healthcare endoscopy sites, which shows the readmission rate ranges from 1.2 to 5.4%. 60.4% of the patients returned to the emergency department are unrelated to the procedure. 38.5% of the readmissions were either directly, indirectly, or probably related to the procedure. We also tried to track and see how soon patients returned to the ED after the procedure. Our data shows that 34% of the patients returned within two days after the procedure. 36% between three to seven days, and 30% within eight to 14 days. I have a second poll question. What is the monthly outpatient readmission rate in your endoscopy unit? A, less than 2%. B, between 2% and 4%. C, more than 4%. D, I'm not sure. E, not tracking. Thank you for your responses. Majority of the response answers A, less than 2%. We found that the readmission rate for patients returning within two days was 34%. We believe the site could improve by implementing 24 to 48 hours post-procedure calls. This will also indirectly improve our patient experience. To improve this, we are implementing a post-discharge outreach where patients will receive a phone call or text message one day after their discharge. This communication will include clinical and service-related questions such as general status of symptoms, discharge instruction and medication inquiries, and patient feedback. With this outreach, two attempts will be made to contact the patient. If a patient replies indicating a need for further follow-up, the nurse will be notified and will contact the patient within two hours. Based on the nurse's judgment, they may connect with a provider or pursue other interventions as necessary. HEPA Healthcare proudly implemented the outpatient readmission notification last year, and now, with the use of the data we collected, we aim to reduce readmission with a rollout of outreach calls on February 24, 2025. This post-transition follow-up will be a two-way text messaging platform to facilitate automated communication with patients. The patient will be able to respond to scripted questions, and any concerns can be escalated to a nurse in charge. This will help eliminate unnecessary calls by a nurse as we in healthcare are already struggling with staffing issues. The primary objective is to improve patient outcome, safety, and experience while maximizing the transitional care management and decreasing the readmission rate. Last poll question. Does your endoscopy unit make follow-up calls 24 to 48 hours after the procedure? A, yes. B, no. C, sometimes. D, I'm not sure. Thank you again for the responses, and majority of the responses for this poll question answered A, yes. Thank you for allowing me to participate in the ESG GI Unit Leadership Polls.

Quality Improvement

readmission rates

endoscopy procedures

patient communication

transitional care