How rounding is helping hospitals reduce patient readmissions

Hospital readmission rates are declining and there are several contributing factors. One of the main factors is that reducing patient admissions within 30 days after being discharged from an earlier hospital stay, whether the patient is admitted at the same or a different hospital, or for a different reason, has been a tremendous focus with the implementation of the Hospital Readmission Reduction Program (HRRP). A provision in the Affordable Care Act established the HRRP, which requires the Centers for Medicare and Medicaid Services to reduce payments to Inpatient Prospective Payment System hospitals with excess readmissions in October 2012. Facing penalties and reimbursement reductions, hospitals have taken a proactive approach to ensuring readmissions are minimized.

“Readmission rates will continue to naturally decline as the focus on the patient and the quality of care continues,” says David Chimento, Client Services Manager at Sentact. “In addition, penalties and reimbursement reductions will continue to drive hospitals and health care networks to focus on reducing readmissions.”

Smart Business spoke with Chimento about hospital readmissions and what hospitals are doing to keep readmission rates down.

What are the issues associated with readmissions?

Readmissions are generally associated with congestive heart failure, blood infections (Septicemia), Pneumonia, Pulmonary issues and Cardiac dysrhythmias. These impact individuals of any background and all ages. Most issues that need to be addressed are around recovery instructions, quality of caregiver communications and how well a caregiver responds to a patient’s needs.

How can hospitals lower readmissions? What are some of the proven methods?

Hospitals can lower readmissions through rounding. Here are five top rounds that are proven to reduce hospital readmissions.

  • Pre-Admission Rounds: Get a jumpstart on communication with patients during pre-admission rounds. Educate patient on procedures, surgeries, treatments, medications and exercise management before they occur. Rounds such as these have been proven to reduce readmissions by 12 percent.
  • Infection Prevention Rounds: Infections account for 1.2 percent of every 1,000 patients readmitted to a hospital. Use rounding to ensure proper hand hygiene, pressure sore management, as well as other infection protocols that reduce infection both during patient stay and after discharge. With better infection control programs and improvement processes, readmission rates decline.
  • Employee/Leadership Rounds: Using employee and leadership rounds, hospitals can determine areas that need improvement, such as training and quality. A well-trained staff is better prepared to educate and prepare for a patient discharge. In addition, employee and leadership rounds support a patient-centered care concept where all parties are communicating, ensuring discharge occurs when appropriate.
  • Nurse Rounds: It has been proven that nurse presence with hourly rounding throughout the stay prepares patients and educates patients on the discharge process, as well as what to expect after the discharge process. In addition, nurses who complete hourly rounds can identify early warning signs of complications or adverse events that could prevent a discharge.
  • Post-Discharge Rounds: Completing discharge rounds, as well as follow-up discharge rounds, ensures patients have a complete understanding of their medication timing, dosage and frequency. It also offers an opportunity to ask questions and have complete clarity — a complete understanding of discharge plans — and receive complete information on post-discharge care.

What do hospitals tend to miss or get wrong as they work to reduce readmissions?

With a true focus on reducing readmissions, hospitals don’t tend to miss much. It is the lack of focus or process improvement that causes readmission rates to increase. Rounding can help hospitals focus on areas that are causing readmission rates to increase. Whether is it communication or quality of care, these areas can be identified and corrected quickly to reduce readmissions.

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Keeping nurses happy should be a top priority for health care organizations

Many health care organizations are facing similar struggles as they attempt to deal with the high rate of nurse turnover.

“Nurse turnover is higher in emergency room departments, which can be attributed to burnout. However, the issues that generally leads to nurse turnover are the same across the acute care environment,” says Chris Dube, president of Sentact. “For example, extensive turnover tends to occur when nurses are not happy. This leads them to seek out a new work environment.”

Dube says that nurses leaving for better work environments tends to occur when staffing levels at their current workplace are not adequate, communication is not transparent, process improvement is non-existent, and wages are not competitive.

Smart Business spoke with Dube about nurses: the factors that lead to their turnover and how organizations can make improvements to keep them happy so they’re less likely to leave.

What organizations have the most trouble with nurse turnover?

Many organizations face the same struggle with nurse turnover, regardless of type. It really comes down to nurses’ happiness. The demand in the market for nurses is so high that they can leave an organization and have a high degree of confidence that they’ll find another position with better conditions.

What is it that tends to make nurses unhappy?

There are many factors that contribute to a nurse’s happiness. Clearly competitive wages and adequate staffing are two of the leading factors. However, there are other components that impact their satisfaction level. Those include elements such as:

  • Minimal obstacles: Organizations should work to remove as many obstacles to patient care as possible. Nurses don’t want to have to jump through hoops to just take care of a patient.
  • Adequate resources: Having the equipment, devices and supplies available that nurses need to care for patients directly impacts nurses’ level of satisfaction. Nurses don’t want to have to search a hospital wing for a piece of equipment. Rather, they want to be able to locate medical devices quickly and efficiently. Searching for needed items takes valuable time away from patient care.
  • Managerial support: Managers should be able to demonstrate their understanding of issues such as training, daily obstacles and red-tape. This helps improve the satisfaction rate of nurses dramatically.

Organizations can easily track how happy their nurses are by completing simple rounds that are focused entirely on employee satisfaction. Health care organizations can gauge whether or not they’re creating a good working environment for nurses by asking such questions as:

  • Do you have the necessary resources to do your job?
  • Do you feel as if the organization gives you the opportunity to learn and grow?
  • Do you feel as if your colleagues are committed to the success of the organization?

But more than just asking the questions, organizations must respond to the results of these rounds to show that they are providing the nurses with all that they need to feel that they can adequately tend to the needs of their patients.

Why is it important for organizations to keep their nurses happy?

It is critical that organizations keep nurses happy as nurses directly impact patient satisfaction. The longer they remain in service at the hospital network, the more they contribute to the bottom line.

Reducing employee turnover in a nursing staff by just 1 percent translates to a substantial savings to health care facilities.

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How to establish a system to mitigate hospital-acquired infections

Hospital-acquired infections continue to be an issue in health care settings. Despite the progress that’s been made to identify the common causes of the infections and prevent them from happening, they are still a frequent occurrence. According to the Centers for Disease Control and Prevention, on any given day, about one in 25 hospital patients has at least one of these types of infections.

Though the problem persists, there are steps hospitals can take to mitigate the issue. It requires discipline, communication and a concerted effort from all levels of hospital staff to reduce or eliminate hospital-acquired infections, but it can be done.

Smart Business spoke with Chris Dube, president of Sentact, about hospital-acquired infections and creating a system to address them.

What is the most recent trend as it relates to hospital-acquired infections? Is it getting better, worse, or staying about the same?

Hospital-acquired infections continue to be a focus for health care networks because of the vast number of infections that patients can acquire. For example, some of the top hospital-acquired infections are central line-associated bloodstream infections, surgical site infections, catheter-associated urinary tract infections and ventilator-associated infections. Given that infections such as these impact more than 750,000 patients every year, the trends are unfortunately remaining the same.

Where do hospitals typically go wrong in trying to address this problem?

Hospitals often do not have the resources, technology and expertise to correct the long-term problem of hospital-acquired infections. To begin to address the issue, hospitals must have a centralized effort from all areas, including facilities, care teams, doctors and nurses, as well as the tools to support these teams. When addressed properly, hospital-acquired infections in a hospital can drop by as much as 70 percent.

Does the risk tend to rise and fall with the time of year?

Hospital-acquired infections are not necessarily impacted by the time of the year. Rather, some of the key causes are poor handwashing techniques, poor insertion techniques, contamination of medical devices and the lack of proper protocols.

What’s the key to creating a system that is effective and fits into the daily workflow for those who work in the hospital?

Hospitals employ many different methods to prevent hospital-acquired infections. However, implementing a solution is often not enough.

To combat the rising threat of these infections, organizations need to ensure that all staff members adhered to the infection control processes. This is where rounding plays an important part in the process. Rounds can serve as checklists for a hospital’s infection control staff to ensure that hospital policies are followed.

The following are critical elements for hospitals to implement with rounding initiative:

  • Determine the frequency that works with your hospital based on its size and staffing levels.
  • Target surveillance and rounds on high-risk areas until improvement occurs.
  • Establish immediate notifications upon discovery of hospital-acquired infection-related problems so corrective actions can be taken immediately.
  • Immediately report issues to leadership so that corrective plans can be created and/or implemented. Communication should be transparent.
  • Create a process for areas of improvement that are discovered in order to fully correct the issues.

Automated rounding can address these critical elements to promote patient safety.

Implementing a rounding solution that focuses on hospital-acquired infections can reduce and eliminate them in an organization.

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How to make safety monitoring a part of your routine

Hospitals assess patient safety through many different metrics that include compliance with both regulatory and national patient safety goals.

However, to achieve these goals, it is important that hospitals complete rounds that support performance. Rounds based on programs such as Environment of Care, Life Safety, Infection Control and National Patient Safety help to ensure that the hospital has the necessary processes and policies in place to ensure patient safety.

Smart Business spoke with Lynn O’Donnell, MBA, Director of Communications at Sentact, about what hospitals can do to continuously improve safety in their locations.

How do you assess your hospital’s performance when it comes to patient safety?
While each hospital is a unique place and may take a slightly different approach to how it completes work, safety and quality do not allow for much gray area.

Rounds by their very nature are created to develop a routine of checking on patients or monitoring the environment in the hospital. Safety monitoring works best when you highlight the following behaviors:

  Increase awareness on safety issues and make them an organizational priority.
  Communicate with staff regarding current safety issues within the hospital.
  Educate the team on patient safety concepts.

It is recommended that hospitals conduct weekly safety checks because they help to tie together all rounds and corresponding data in a way that can be easily analyzed and communicated to staff/team members.

What are some of the most common oversights when it comes to patient safety?
Many organizations assume that by measuring safety with different types of rounds, a hospital has a safe patient environment. This is only one step in the process. It is important to not overlook the deficiencies that are found during these rounds and review areas that require additional focus.

In addition, a plan for corrective action should be put in place so items are addressed, as well as a strategy to create a plan for improvement so that the same deficiencies don’t continue to repeatedly occur.

How challenging is it to measure whether you have a safe environment?
There will always be elements outside of your control that threaten the safety of your hospital.

However, it is still not difficult to maintain a safe environment if you have the appropriate solutions in place and you instill the commitment needed to continue these practices on a regular basis.

Using a comprehensive rounding solution that gathers data across all disciplines and provides analytics and reports can help an organization determine if it has a culture of true safety, or if steps need to be taken to improve safety.

How do you get everyone engaged in the effort to create and maintain a safer environment?
It is recommended that hospitals incorporate the following practices into their routines:

  Identify your team — Select the appropriate personnel to be included in your weekly safety checks. Individuals should be early adopters of technology and be chosen across different levels such as managers or directors, executives and patient safety personnel.
  Schedule your weekly checks — Strive for consistency by using the same day of the week so your team can schedule their own daily activities to not conflict with rounds, helping to ensure that they don’t lose focus and engagement.
  Complete weekly checks —  Follow the schedule created, complete the necessary weekly checks with a singular focus on safety and record all the data.
  Review data from weekly checks —  Review the data collected with the team and share with other personnel so that you gain both adoption and engagement.

Create a framework that executes best practices and communicates across the health care network so that success engages other participants. Rounding has a great impact both on patient safety and on creating a safer environment for patients.

Insights Health Care Technology is brought to you by Sentact

Leaders bring credibility to the practice of hospital rounding

While weekly safety rounds demonstrate an organization’s commitment to safety, leadership walk rounds are an opportunity to further reinforce that promise by bringing managers and leaders out of their offices and onto the hospital floor, says Mark Hudson, Strategic Accounts Manager at Sentact.

When used together, these two rounding practices help to create a safer environment for everyone.

“Our customers have found that if the individuals at the top level are also performing rounds, not only will it provide buy-in so your nurse managers continue to do those weekly safety rounds, but your patients get to see the administration of the hospital and see that they care and that they are listening,” Hudson says. “These interactions can only help in the effort to continuously improve patient care at every level of the organization.”

Smart Business spoke with Hudson about how to work with your team to help them understand the value of these rounding practices.

How do you get everyone to understand the importance of being safe in their work?
Getting buy-in is always an issue. Communication is the best method to get everyone to understand the importance of being safe in their work. By reviewing the data that is collected during the rounding process, you can identify issues and deficiencies that need to be corrected.

By communicating these issues and developing a corrective plan, individuals can see how they impact the safety of an organization. Once you see results from a corrective plan, it’s critical that they be shared with your team so that they can see and participate in the process improvement taking place.

There are also other forms of positive reinforcement such as publishing patient feedback and communicating an increase in Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores.

How do you create a system to ensure that the safe culture continues beyond the initial conversation?

  • Improve communication among and from hospital leaders — Using the data collected from a rounding solution for patient safety and quality, leaders can easily determine areas that need correction or improvement, communicate these quality measures to the team and provide the resources and training necessary to promote learning and continuous improvement.
  • Create transparency — Using a structured rounding routine, caregivers can contribute to efficiency, safety and teamwork, as well as address patient satisfaction. With purposeful rounding, an environment of transparency is created and health care organizations will see a reduction in patient anxiety, patient falls and readmission rates. A transparent environment creates a culture of trust between the patient and caregiver and it all begins with rounding.
  • Create continuous improvement — Inevitably, issues or deficiencies are discovered during the rounding process. A robust rounding tool will allow an organization to not only correct the issues as they occur, but also help an organization track data so that processes for continuous improvement can be created. Taking a proactive approach reduces the likelihood of experiencing adverse events.
  • Create actionable data — Manual rounding processes do not provide a health care organization with the proper data to make decisions. Scrolling through paper can take hours of time, which could be better spent directly interacting with patients. With an automated rounding solution, analytics and reports can help an organization make management decisions in real-time.
  • Create a culture of safety — All health care organizations are working towards a culture of safety, but some may struggle with exactly how to reach their goals. Rounding can assist these organizations by being a valuable tool in this process. By reporting and learning from patient and quality rounds, health care leaders, managers and team members can create a true culture of safety.

Insights Health Care Technology is brought to you by Sentact.

How communication and technology can improve overall patient experience

One of the most difficult components of an effective rounding program is getting buy-in from the staff that will be out on the floor performing rounds, says Chris Dube, COO at Sentact.

“Nurse managers have many fires to put out every day,” Dube says. “Caring for patients with multiple and unique needs takes a great deal of focus. A rounding process needs to be efficient and easy for staff to collect data, identify problems and solve them.

“Getting nursing to buy in to this process is essential. Without that understanding, you may see scenarios where there are positive rounding results, but poor Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores.”

The discrepancy in the data provided by internal rounding and HCAHPS results reinforces the value of getting buy-in, Dube says. “If you’re not resolving issues found during rounds and it’s not efficient, I don’t know that you’re going to get buy-in from the nurses performing rounds,” he says.

Smart Business spoke with Dube about how effective rounding can help improve HCAHPS results.

What accomplishments can be reached through effective rounding?
When you’re rounding on the floor, you’re identifying issues, concerns and problems that could be related to the hospital environment, cleanliness or safety. You’re also fielding patient complaints and supporting communication among caregivers. You learn about these issues and you work to resolve them, ideally before they become patient satisfaction or safety issues.

There are times when you learn about an issue and there is service recovery on the back end. There was a problem and you’re able to fix it. That can create a very positive outcome for a patient and the ability to provide service recovery is huge for a hospital. It’s a process that can be helped by an effective, planned and well-thought-out rounding process.

Hospitals are large organizations, some of which have thousands of employees and communication is often a huge challenge. Often, there is a large gap between staff-level employees and senior management that results in a failure to fully explain new initiatives to the different departments and functions that make up a hospital.

Rounding ensures the lines of communication are open so that this information can be shared, which is critical to creating a strong organization.

How has the process of rounding changed?
There was a time when rounding was a very siloed process among certain leaders in certain departments. Rarely was it a cross-functional activity where you had different departments going into a room and communicating with each other.

Multi-functional, multi-disciplinary rounding has become much more prevalent, along with the frequency of rounding. Technology has been a big part of making the process more efficient. Automation allows those findings that took a series of meetings and phone calls to resolve and made the resolution process much more streamlined and focused.

What is the idea behind comprehensive rounding?
You can take all the disparate rounding functions that are happening throughout your organization and consolidate them into one solution for easy automated data collection. The idea of comprehensive rounding is one technology platform where you can round for patient satisfaction, environment of care, life safety, nursing, lab, pharmacy or other areas.

You’re able to track and trend those data points and find ways to improve. Having it all on one platform is huge when it comes to the data behind it. Data is the key to improving. If you’re just performing rounds and you’re not solving problems, or tracking how you’re doing, you’re not going to improve.

The goal should be to use an internal rounding process not as a guide to how you’re doing, but rather as an attempt to improve key indicators such as patient outcomes, readmissions and patient safety and satisfaction scores.

Those are things you should care about as a hospital and things that will improve your HCAHPS results.

Insights Health Care Technology is brought to you by Sentact