Admission program wins JCAHO award
Admission program wins JCAHO award
Agency speeds up referrals, improves education
When Parker Jewish Institute for Health Care and Rehabilitation in New Hyde Park, NY, implemented a streamlined therapy evaluation procedure, it really only hoped to improve the timeliness of visits and calls between therapists and nurses. Along with that laudable result, the program garnered the rehabilitation agency the 1999 Earnest A. Codman Award, presented by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) on Nov. 4 to honor health care organizations that use outcomes measurements to achieve quality improvement.
The process began in January 1998. During routine monthly chart reviews, Roxanne Santangelo, PT, rehabilitation supervisor at the Parker Jewish Institute, noticed that the timeliness of initial therapy visits — for physical, occupational, and speech therapy — left something to be desired.
"Our statistics showed that only 67% of the visits were timely," she says, adding that for their agency, timeliness for priority-A patients meant a visit within two days of referral, and for priority-B patients within five days. In addition, the calls between the therapist and nurse after that initial visits were wanting, with only 64% of the calls happening within the prescribed 24-hour time frame.
When discussions arose about what Santangelo wanted to work on for her performance improvement (PI) project that year, it seemed like an obvious choice.
Input from all sides
She put together a multidisciplinary PI team that included an intake nurse, an admissions assistant, a staff RN, a clerical medical scheduler, and herself. "Everyone was from a different area, but all had input into the process," she explains. "They all touched it somehow." Initially, the team met every other week.
They started out doing a complete flowchart analysis of what happens when a patient is admitted and is referred for therapy. "Immediately, we noticed some things we could do for a quick improvement," says Santangelo. For instance, not all intake managers handled referrals to therapists in the same manner. Some would wait until all the paperwork was done to refer a patient. "Now, we have a process where as soon as we know there is going to be a referral it is forwarded to the intake admissions assistant."
Santangelo says the team next tried to identify why visits were not occurring within the prescribed time frame. The top three reasons: the therapy referral was delayed in the office; there were language barriers with some patients that prevented the therapist from scheduling an appointment in time; and the therapists were sometimes working in a different geographic area on a particular day and could not make the appointment on time.
Each of those top three problems resulted in some simple solutions. One main reason for the interoffice delays seemed to be that when an admission assessment indicated that a patient would need therapy, the nurses would often fail to forward the paperwork until days later, says Santangelo. Now, the referral is to go out before the nurse does. This change was accomplished through inservicing of staff.
The language barriers also required education — but this time of both staff and patients. "We had a translation system in place through an AT&T operator program," says Santangelo. "I was surprised that they weren’t using it, that they didn’t seem to know about it. They seemed to need a nudge in that area."
Along with reminding therapists of this program, nurses were inserviced to ask non-English-speaking patients to have a translator — a family member or neighbor — when the therapist called to make an appointment, and also during the first therapy visit. The institute eventually hired a Russian-speaking therapist.
The geographic problems that arose when therapists were not working in the right area gave rise to a policy that forbade the therapists to take a case if they can’t make their initial visit within two or five days, depending on the patient’s prioritization level.
Santangelo says that by September 1998, the program was in place and a second set of data was collected. The timeliness of visits had improved to 83%.
Still improving communication
The problem of getting therapists to call the nurses within a day of doing the initial visit turned out to be something less — and something more — of a problem than Santangelo anticipated. While the initial numbers indicated that the calls weren’t being made or weren’t being made on time, further investigation showed that wasn’t the case. In some instances, the calls were being made, but were not being documented. In other cases, the therapist would do a visit on a Friday, make the call on a Saturday, and the office voice mail wouldn’t be picked up until Monday. The nurse’s notes in such instances seemed to indicate that the call was not made within that 24-hour time frame.
While the latter problem is still something the agency has to combat, the former issue was dealt with simply. "If I called a therapist and asked if they made the call to the nurse and they said they did, I would return their notes and make them fill it in," says Santangelo. "It was an education process. It wasn’t that they were resistant to the rule. It was just something that slipped their mind."
Making a list
Along with the great statistical improvements that occurred on this specific PI program, there were other benefits, says Santangelo. For instance, when inservicing the therapists and nurses for the changed procedures, she found there was some lack of completeness in the calling report between the two. The agency created a telephone calling sheet that had spaces to fill in appropriate important information. The therapists used the new form to jog their memories and assure that the nurses got the relevant information. "It was a side process, but it improved our communication because it made them go through a list," Santangelo says.
Judy Moomjian, RN, MPA, CHE, CPHQ, vice president for quality management and regulatory affairs at the agency, says that the process improvements made were relatively simple, and all revolved around improving communications. "Often people don’t realize the significance of little changes," Moomjian says. "This kind of program, and being recognized for our efforts by an external source like JCAHO, will help everyone to understand the value of doing small things. I really think this will impact all of our quality improvement programs. I think it will make my job easier."
Rehabilitation Chart Review Figures | |||||
Dates | # of Charts | Timeliness of First Visit/# Meeting Goal | Percent Meeting Goal | Initial Phone Call within 24 Hours/# Meeting Goal | Percent Meeting Goal |
Baseline | |||||
(January 1998) | 70 | 47 | 67 | 45 | 64 |
September 1998 | 70 | 58 | 83 | 57 | 81 |
December 1998 | 70 | 63 | 90 | 52 | 74 |
March 1999 | 70 | 59 | 84 | 52 | 74 |
June 1999 | 70 | 63 | 90 | 45 | 54 |
• Judy Moomjian, RN, MPA, CHE, CPHQ, Vice President for Quality Management and Regulatory Affairs, Roxanne Santangelo, PT, Rehabilitation Supervisor, Parker Jewish Institute for Health Care and Rehabilitation, 271-11 76th Ave., New Hyde Park, NY 11040. Telephone: (718) 289-2250.
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