hallmark health system bi-directional transfer: skilled nursing facility to ed and back
TRANSCRIPT
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HALLMARK HEALTH SYSTEM
Bi-directional Transfer: Skilled Nursing Facility to ED and Back
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Hallmark Health System
• Community based, non-academic, non-profit• 2 acute care facilities• Melrose-Wakefield Hospital
• 234 licensed beds
• Lawrence Memorial Hospital• 134 licensed beds
• HHMA: multispecialty practice• Cancer Center• Hybrid medical staff model• Hospitalists• 70% admissions arrive through the ED
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Hallmark Health System
• Melrose-Wakefield Hospital• 42,000 patients annually• 18 beds (8 hallway beds)• Behavioral Health area: 5 beds
• Lawrence Memorial Hospital• 18,000 patients annually• 8 beds (5 Hallway beds)• UCC 13,000 patients annually
• Paper charting system• Electronic Tracking board• Meditech IS system
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Hallmark Health System
• ED Medical Staff• 20 Physicians• 17 Physician Assistants
• Schedule ~ 1.8pts/hr• Single coverage 5 providers at one time
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First 9 months: 2011
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Continuum of Care
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How did we get there?
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“You can’t solve problems by using the same kind of thing we used when we created them”
Albert Einstein
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“If you don’t know where you are going, you’ll end up someplace else”
“If you don’t know where you are going, you might not get there”
Yogi Berra
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What didn’t work
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“Of course I believe in teamwork. I believe your team should do all the work.”
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What didn’t work
• Unilateral Communication• Unilateral Decisions• All-or-nothing thinking (Black-and-White)• ED’s perspective• Primary Care/Geriatric specialist perspective
• “Too complicated” solutions• Trying to change everyone’s behavior at one time
• Case manager in the ED
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What did work
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What did work
• Identifying a Champion • Point person
• Educate and understand “the why”• Understand the capabilities of both the SNF and the ED
• Define what success is• Characteristics and metrics• Graduated success
• Move away from all-or-none
• Play to people’s strengths/style• Don’t need to “change” a practitioner’s style
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What did work
•DATA•FEEDBACK
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What did work
• Standardization
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Standard Interact Form
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Current State: Available on Site
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First 9 months: 2011
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Continuum of Care