What Was Done?
Global Problem Addressed
The oncology surgeons felt that the number of readmissions, within the first 30 days following surgery, was higher than the national average following GI oncology surgeries.
Identification of Local Problem
The readmission rate for GI oncology surgeries on 5 South from January 2015 to May 2015 was 14.77 percent, which exceeds the national readmission threshold of 12 percent. The total direct cost for all of the readmissions for the same time period was $145,355.40.
How Was the Quality Improvement (QI) Activity Put in Place?
Context of the QI Activity
WellStar Health System, the largest health system in Georgia, is known nationally for its innovative care models focused on improving quality and access to health care. Staying ahead of the curve in technology has enabled WellStar to be leaders in both the diagnosis and treatment of an extensive array of health conditions.
Serving a diverse population, WellStar consistently looks at total patient wellness and works to ensure that all systems support that focus. WellStar is recognized nationally as an Employer of Choice and is featured on FORTUNE 100 Best Companies to Work For® list and Work Mother Magazine's Best Companies list.
Specialists and primary care providers work in a multidisciplinary environment with 20,000 team members throughout our 11 hospitals, 225 medical office locations, outpatient centers, health parks, a pediatric center, nursing centers, hospice, and homecare. By working through a patient-centered model of care, WellStar places enormous value on quality and safety with many accolades to support our work.
WellStar's senior leadership, board of trustees, authority, regional, and foundation boards evaluate our community's emerging needs to equip our facilities with the best new technology. We know that healthy patients come from healthy neighborhoods, and finding ways to deliver better care in metro Atlanta is a big part of who we are. As a not-for-profit, WellStar continually reinvests into the health of its communities through new treatments, services, and facilities.
Planning and Development Process
The team was developed based on subject matter experts in oncology, surgical services, physician offices, and experience with Six Sigma. A SIPOC was created to make certain all members who should be involved were part of the committee.
Description of the Quality Improvement Activity
- The project approach used the DMAIC problem-solving methodology.
- Strategic goals were outlined.
- Decrease re-admission rate for GI oncology surgeries on 5 South to less than 10 percent by December 31, 2016.
- Decrease the direct cost of readmissions by $50,000 by December 31, 2016.
- A process map was created to delineate each step of the process after discharge.
- A fishbone diagram was created to determine root cause problems.
- Intervention developed by the team:
- A system for increasing the frequency of phone calls to the patients following surgery by the physician office staff.
- Develop a post-surgical zones document to be given at surgical discharge to educate patients on symptoms to watch for and when to notify the physician or emergency care.
- Develop an education booklet in conjunction with a class that explains the pre-op instructions, what will happen during the hospital stay, and what symptoms to look for after discharge. An insert of an illustration of the specific surgery will be included for each patient.
- Develop an individualized pre/post-op class based upon the patient's surgical procedure to be facilitated by the nurse navigator.
Resources Used and Skills Needed
Team Members
- Barbara Wilson, Director Oncology Professional Practice
- Magali Huertas, GI Oncology Navigator
- Nancy Page, GI Oncology Navigator
- Kristen Lang-Coleman, 5 South CNL
- Leigh Webb, LSS Green Belt
- LouAnn Sago, Manager, Summit Surgical
- Pam Beckwith, Nurse Manager, 5 South
- Anju Nair, LSS Green Belt
What Were the Results?
During the brainstorming session, the team determined that the appropriate collection of data would be measured by percentage of patients who were readmitted following a GI oncology surgery for a direct surgical postoperative complication.
The team also determined it was important to capture the amount of the direct cost for the admission for these patients, which is not reimbursable by insurance companies/CMS (Table 1).
