Sharing resources helps create cost-effective DP

Hospital also uses collaboration to improve outcomes

As hospitals nationwide seek ways to reduce their readmission rates and improve quality, they are having to make improvements with fewer resources.

So, one strategy is to seek collaborations from other departments and researchers in the hospital system, looking for ways the two groups can pool resources and reduce redundancy.

For instance, when the Medical University of South Carolina (MUSC) in Charleston, SC, became involved in Project BOOST, the physician champion for Project BOOST looked for other active initiatives at MUSC to find natural collaborative fits.

Project BOOST - Better Outcomes for Older adults through Safe Transitions — is sponsored by the Society of Hospital Medicine in Philadelphia, PA, through a grant from the John A. Hartford Foundation.

Through a collaboration, a hospital can improve funding for particular positions and more quickly spread best practices and helpful tools, says Neal Axon, MD, an assistant professor of internal medicine and site director for Project BOOST at MUSC.

"When we started with BOOST, we made sure we included other initiatives active at MUSC," Axon says.

A tertiary care university center with a wide variety of patients, including chronically ill and indigent patients, MUSC has a challenging patient population, Axon says.

The organization became involved in Project BOOST as a way to improve its readmission rate on the internal medicine unit, which is attended primarily by resident teams, he explains.

"We chose that unit because we have a readmission rate on that unit that represented an opportunity for improvement," Axon says. "So, we wanted to use Project BOOST as a first step of continuing quality improvement strategy as part of re-engineering the discharge process."

Axon and other BOOST leaders were aware of several other MUSC initiatives to improve the discharge process, and they thought there might be an opportunity to collaborate and take advantage of these.

"What we wanted to avoid is having three or five small camps of people in the medical center working on essentially the same problem," Axon says. "We wanted to bring everyone onto the same page."

For example, the institution already was involved in a project called Aging Q3, which involves teaching geriatric care to medical students and resident doctors, Axon says.

Aging Q3 is focused on improving the quality of education, care, and life for older patients, and it is the result of a $2 million grant, covering 2009-2012, from the Donald W. Reynolds Foundation.

The Aging Q3 grant funding partially pays the salary of the nurse/research associate position, while the hospital also contributes a portion of the salary on behalf of Project BOOST, Axon adds.

"So, having these two projects running in parallel has allowed for collaboration," Axon says.

"For example, some of the curricula we're going to be developing for Aging Q3 fit very nicely with Project BOOST," he says.

"And there's funding for a nurse/research associate through this separate grant," he adds. "It's far from done, but they're in the process of writing a job description and hiring a person who will help facilitate the execution of the grant with a portion of that person's salary being paid by our hospital in support of Project BOOST."

The focus on improving discharge planning also will be aided by the hospital's adoption of a computerized provider order entry (CPOE), which soon will be rolled out. It will include a revised discharge order set, Axon says.

Another collaboration involved the hospital's cardiology group, which had been considering participation with the Hospital to Home (H2H) national quality initiative, cosponsored by the American College of Cardiology and the Institute for Healthcare Improvement, Axon notes.

"H2H is very well done and has many features similar to BOOST, so they sought me out as somebody who was knowledgeable about BOOST," Axon says. "So, we're likely to be working with them to implement BOOST with a twist for heart failure patients."

If Axon had not publicized among MUSC's staff the hospital's focus on improving discharge planning and care transitions, then the cardiology physicians might have invested time and resources into a separate program that would have duplicated some of the ongoing efforts under Project BOOST, he says.

"I can promise you that I'll be tapping on them for assistance as we configure and recalibrate our quality efforts around congestive heart failure and myocardial infarction because they're the experts in that," Axon says. "And they do that better than other parts of our medical center that don't see as much heart failure."


For more information, contact:

• Neal Axon, MD, Assistant Professor of Internal Medicine; Site Director for Project BOOST, Medical University of South Carolina, 135 Rutledge Ave., MSC 591, Charleston, SC 29425. Telephone: (843) 792-2900. Email: