WEBVTT 1 00:00:02.240 --> 00:00:04.520 Christopher Henry: This meeting is being recorded. 2 00:00:16.880 --> 00:00:17.770 Okay? 3 00:00:17.820 --> 00:00:30.510 Quality Insights: Well, good afternoon and welcome to Today's Webinar on. Nobody puts baby back in the er love that title, Chris. We will get started in just a few minutes. But first just a few housekeeping items. 4 00:00:30.520 --> 00:00:51.480 Quality Insights: All participants entered Today's Webinar in Listen only mode. If you have a question or a comment during today's call, we just ask that you please type that into either the chat or the Q. A. Box which should be located at the bottom of your zoom window. You may need to hover your mouse around the bottom of the window to get the icons to appear. Sometimes they like to go to sleep or disappear on their own. 5 00:00:51.980 --> 00:01:02.160 Quality Insights: At the end of today's program. You'll be directed to an evaluation. We hope that you will complete the evaluation as it helps. Tell us how we did and how we can shape our future programming for you. 6 00:01:02.380 --> 00:01:19.540 Quality Insights: So we have some great information to deliver today. So without further ado, i'd like to introduce our presenter for the Webinar Christopher Henry Christopher Henry is a quality and improvement specialist here at quality insights. He's a masters prepared nurse, who has been in health care for over thirty years. 7 00:01:19.550 --> 00:01:29.190 Quality Insights: He served in various health care leadership roles from assistant director of nursing director of nursing, and as a as a nursing home administrator. 8 00:01:29.280 --> 00:01:44.119 Quality Insights: He's worked in every component of health, care from hospitals, home, health, long term care and clinical care, including his last position as the Director of Nursing and Employee Health Coordinator for a federally qualified health center here in West Virginia. 9 00:01:44.130 --> 00:01:52.029 Quality Insights: So welcome, Chris, and thank you for bringing your insight and expertise to us today, and i'll now turn the program over to you. 10 00:01:52.560 --> 00:01:53.740 Christopher Henry: Thank you. 11 00:01:53.910 --> 00:02:10.390 Christopher Henry: I appreciate it. Welcome everybody. I hope this is informative. Um, as you can see from my title. Nobody puts baby back in the er. It is a not to dirty dancing. Um, so. Um! I hope you enjoyed the title, and uh the the presentation today. 12 00:02:10.850 --> 00:02:23.250 Christopher Henry: Um, we weren't able to use our dirty dancing because it was copyrighted. So we did throw it uh the lift there for you all, uh, just to remind you of the title of the of the presentation. 13 00:02:24.530 --> 00:02:43.679 Christopher Henry: All right. So our goals today are to discuss the number of re-emissions nationwide specifically for West Virginia and Pennsylvania Um. We will also look at causes excuse me and risks for readmissions. We'll be examining contributing factors. The cause, the readmissions 14 00:02:43.690 --> 00:03:02.719 Christopher Henry: Um. One study I have from the Joint Commission uh looks at um a significant amount of months of Covid, nineteen, and remission practice. And then we also will identify areas in ways we can decrease the number of admissions. Of course, that is the goal of this Webinar. 15 00:03:03.860 --> 00:03:09.300 Christopher Henry: I will preface this presentation and the fact that, 16 00:03:09.690 --> 00:03:24.860 Christopher Henry: and it seems like just forever ago. But it was only in December of last year and January of last year that Amicron started showing up in our communities. Um! And then, of course, the variance of those since then 17 00:03:25.200 --> 00:03:44.120 Christopher Henry: so unfortunately, um. I am not able to present information on uh more up to date information on the amicron and other variants. For this year Cms and Cdc has not released information as far as regarding readmissions based on that, 18 00:03:44.410 --> 00:03:47.609 Christopher Henry: so the most information I can present. 19 00:03:48.230 --> 00:04:07.229 Christopher Henry: Excuse me, I have a frog in my throat today. Um we'll be from two thousand and twenty-one um, and not this year. Um! We do know that the amoklyn variant hit its peak, or started hitting the United States in December of two thousand and twenty-one, 20 00:04:07.240 --> 00:04:26.389 Christopher Henry: and hit Peak in January of two thousand and twenty-two um, which uh seems so long ago. But yes, it has not been very long ago, so I just wanted to preface the conversation in that fact that, uh, the information I will be presenting will be stuff from two thousand and twenty-one um 21 00:04:26.400 --> 00:04:27.460 Christopher Henry: the year 22 00:04:28.460 --> 00:04:38.110 Christopher Henry: uh the Cdc says basically one in eleven, hey? Uh peak patients will be re hospitalized that we're diagnosed 23 00:04:38.130 --> 00:04:40.820 Christopher Henry: with Covid nineteen initially. 24 00:04:41.500 --> 00:04:58.699 Christopher Henry: Um obviously contributing factors are chronic medical and conditions um their age. Of course, we know that uh sixty-five or over it tends to have more havoc and more hospitalizations or readmissions based on their age. 25 00:04:59.570 --> 00:05:06.920 Christopher Henry: Uh, if they had had host uh had Covid nineteen prior to their admission, 26 00:05:07.090 --> 00:05:11.729 Christopher Henry: or if they've been discharged to a skilled nursing facility or home health care. 27 00:05:14.420 --> 00:05:17.640 Christopher Henry: So when I looked at the Cdc. Numbers um 28 00:05:19.140 --> 00:05:29.460 Christopher Henry: during uh the times of March through July of two thousand and twenty, fifteen percent died Um! During the study 29 00:05:30.120 --> 00:05:38.819 Christopher Henry: and about eighty-five percent survived. Nine of those were re-admitted the same hospital within two months of discharge. 30 00:05:39.050 --> 00:05:40.230 Christopher Henry: So 31 00:05:40.490 --> 00:05:47.119 Christopher Henry: that is close to that Cdc. Number of eleven. Of course there's variant from state to state 32 00:05:47.140 --> 00:05:58.070 Christopher Henry: um, but nine to about fifteen, and I even Sol, as far as up to twenty, some percent uh we're We admitted um During that time period 33 00:05:58.880 --> 00:06:06.919 Christopher Henry: re-emissions occur more often amongst patients that were sent to skilled nursing facilities, probably because the close proximity 34 00:06:07.010 --> 00:06:08.840 Christopher Henry: of each resident 35 00:06:08.880 --> 00:06:20.579 Christopher Henry: for those needing home health care. Um, then, among patients discharge to home or self care. But we would know, uh in general, if somebody is needing home 36 00:06:20.630 --> 00:06:34.539 Christopher Henry: care, that they are also having some uh physical or illness issues that require attention. So that would be expected more of those than sent home to regular just care 37 00:06:36.120 --> 00:06:37.330 Christopher Henry: whoops. Sorry 38 00:06:39.370 --> 00:06:47.909 Christopher Henry: the Cdc. Also said the Um. Possible re emissions increase with age among people sixty, five in order. As we talked about 39 00:06:48.070 --> 00:06:58.029 Christopher Henry: um. They have chronic hospitalizations within the last three months, and that we're um discharged, of course, to the skilled nursing facilities which we already know 40 00:07:00.330 --> 00:07:12.559 Christopher Henry: as far as West Virginia. This was pulled directly from Cms. Uh statistics uh, on re admission rate, on average was fifteen point five, 41 00:07:12.620 --> 00:07:19.050 Christopher Henry: with a benchmark or a low mark of eight point. Four was the lowest we'd seen in any of the counties, 42 00:07:19.510 --> 00:07:22.260 Christopher Henry: so there was five hundred and eighty-three 43 00:07:22.810 --> 00:07:30.330 Christopher Henry: uh admissions. I'm sorry we had uh patients that were diagnosed, and discharged with Covid 44 00:07:30.420 --> 00:07:40.839 Christopher Henry: uh within the first thirty days and then three thousand seven hundred and seventy-three total within a primary diagnosis of Covid, and that was for the two thousand and twenty year. 45 00:07:42.020 --> 00:07:43.700 Christopher Henry: I'm: Sorry. Yeah, twenty, 46 00:07:44.020 --> 00:07:48.289 Christopher Henry: eleven, twenty, twenty through ten, thirty, one of twenty, one 47 00:07:48.340 --> 00:07:52.810 Christopher Henry: year. Um as far as Pennsylvania. 48 00:07:53.510 --> 00:08:01.879 Christopher Henry: They also are almost exactly the same in numbers. Fifteen point nine readmission rate, 49 00:08:02.070 --> 00:08:12.509 Christopher Henry: with three thousand four hundred and twenty-two beings uh have been re-emitted out of two, twenty, one thousand five hundred and eighty for that same time period, 50 00:08:13.530 --> 00:08:20.009 Christopher Henry: and the best at the county ever did in Pennsylvania was eight point, two percent re-emission rate. 51 00:08:23.780 --> 00:08:27.739 Christopher Henry: So when we talked about age being an issue. 52 00:08:28.160 --> 00:08:38.170 Christopher Henry: Um comorbidities also is an issue among those hospitalized with Covid nineteen, the remitted higher um burden of comorbidities than non 53 00:08:38.299 --> 00:08:51.810 Christopher Henry: uh re admitted. Obviously, we would assume that's a case, since most of the re-emissions for Covid are not necessarily related to Covid, and We'll get into that in a further study here in a minute. 54 00:08:52.880 --> 00:09:02.599 Christopher Henry: Within the first twelve days of discharge. Remission reasons were more likely to be associated with Covid nineteen, while those happening later related to other reasons. 55 00:09:02.710 --> 00:09:05.260 Christopher Henry: Um. So 56 00:09:05.640 --> 00:09:10.709 Christopher Henry: once again. We'll talk about those reasons as we get further into the webinar 57 00:09:11.070 --> 00:09:25.749 Christopher Henry: re emissions are greater for those over age sixty-five. We've already established that and the number of desks related to people over the age of sixty-five is ninety-seven times higher than the number of deaths among young eighteen to twenty-nine year old. 58 00:09:29.070 --> 00:09:45.600 Christopher Henry: So a minority helps impact. Um. Obviously, Covid hit our minority populations much harder than some of the other populations uh the risk of severe and illness increases because of underlying medical conditions that they have increases, 59 00:09:45.710 --> 00:09:53.299 Christopher Henry: and some people are at increased risk of getting very sick or dying from Covid because of where they live or work, 60 00:09:53.470 --> 00:10:01.019 Christopher Henry: or because they can't get health care depending on rural areas that we have such as uh in West Virginia and in Pennsylvania. 61 00:10:01.260 --> 00:10:06.800 Christopher Henry: This includes many people from racial and ethnic minorities, and people with the disability. 62 00:10:10.130 --> 00:10:27.539 Christopher Henry: So re uh racial and ethnic groups. Let's look at that. Um. They die at um from Covid at younger ages than um. General Caucasian folks, often younger when they develop chronic medical conditions, and maybe more likely to have more than one medical condition overall 63 00:10:28.050 --> 00:10:43.140 Christopher Henry: as far as people with disabilities, chronic health conditions, and live in shared group settings, face more berries to accessing health care. Uh, was of one of the things that the Cdc. Rec. Uh suggest as an issue, 64 00:10:43.370 --> 00:10:50.730 Christopher Henry: and more likely to get Covid nineteen and have worse outcomes than like I, said the other populations. 65 00:10:53.010 --> 00:11:08.350 Christopher Henry: So the biggest study that I could find on Covid readmission since we don't have a statistics from this year, and the amicron and its variance was a study from the Joint Commission findings on Covid nineteen. 66 00:11:09.220 --> 00:11:17.689 Christopher Henry: They did a study of five hundred and seventy-six patients seventy six of Those had unplanned hospital revisits when thirty days of discharge 67 00:11:17.960 --> 00:11:23.259 Christopher Henry: and twenty-one had ed visits without a mission, fifty-five readmissions 68 00:11:24.020 --> 00:11:27.530 Christopher Henry: the media number of days to revisit was 69 00:11:27.640 --> 00:11:29.850 Christopher Henry: um three to eighteen 70 00:11:31.420 --> 00:11:40.860 Christopher Henry: of the fifty-five patients who were re-emitted nine percent died in the hospital, or were discharged and five percent were re-emitted twice within the thirty day period. 71 00:11:44.590 --> 00:11:57.270 Christopher Henry: Patient um most significant factors for readmissions in this study, where the patient care Mis understand, caregiver. I'm Sorry Misunderstanding of the discharge Medications or instructions 72 00:11:57.720 --> 00:12:02.200 Christopher Henry: inappropriate choice of a discharge location, 73 00:12:02.230 --> 00:12:09.299 Christopher Henry: including, uh sending them to a congregate or skilled nursing facility, where there is close proximity of 74 00:12:09.350 --> 00:12:11.820 Christopher Henry: of uh 75 00:12:12.270 --> 00:12:27.100 Christopher Henry: in adequate in adequate treatment of medical conditions. Um, of course this was before with the peak of um Covid emissions, which happened in January of this year, which seems 76 00:12:27.110 --> 00:12:32.490 Christopher Henry: uh such a long time ago, but such a short time ago, at one point in time. 77 00:12:32.890 --> 00:12:40.320 Christopher Henry: In January of this year we were having a hundred and forty-five thousand emissions a day with Covid. 78 00:12:40.470 --> 00:12:45.119 Christopher Henry: Uh, thank God! That number has been decreasing over the last several months. 79 00:12:45.190 --> 00:13:02.139 Christopher Henry: We are now down to only about one thousand to five thousand total per day in the United States. So over a ninety percent decrease uh, largely excuse me, due to the fact that we have had so many people get the vaccination, 80 00:13:03.240 --> 00:13:10.299 Christopher Henry: and the newer strains have not seemed to have caused um as much hospital admissions. 81 00:13:11.860 --> 00:13:21.510 Christopher Henry: Also, another significant factor for re-admission was discharged without needed procedures uh being kept 82 00:13:22.000 --> 00:13:26.529 Christopher Henry: and patients being discharged too soon. Obviously our. We 83 00:13:26.740 --> 00:13:42.589 Christopher Henry: found out very quickly that our hospital systems were overwhelmed by the number of patients, and by the number of people coming, and that so hopefully in the future will be better prepared for some major event to come our way. 84 00:13:42.600 --> 00:13:54.989 Christopher Henry: Um! If there was any bright point about Covid. That was the point uh the fact that we needed to improve our emergency response and have a better health care system in place to support that. 85 00:13:58.320 --> 00:14:02.080 Christopher Henry: So um, according to the study. 86 00:14:02.200 --> 00:14:10.200 Christopher Henry: Um, we're going to go through the things that could be not directly relate. Some were, look at as directly being related to Covid, 87 00:14:10.210 --> 00:14:25.560 Christopher Henry: and some were not directly related to uh the Covid case in particular. So they looked at the patients. You know they initially were discharged with Covid as a primary diagnosis. And then um looked at reasons why they returned. 88 00:14:26.750 --> 00:14:31.300 Christopher Henry: So the inappropriate choice of discharge, for example, skilled missing versus home 89 00:14:31.630 --> 00:14:33.750 Christopher Henry: um or 90 00:14:34.540 --> 00:14:41.000 Christopher Henry: another facility. Only one of those was directly related to the, 91 00:14:41.220 --> 00:14:49.670 Christopher Henry: to the pandemic itself. Only four were not for only five or twenty five percent of the cases 92 00:14:49.980 --> 00:14:52.750 Christopher Henry: patients just charge you soon 93 00:14:52.880 --> 00:15:07.969 Christopher Henry: uh was only fifteen and follow up appointments not scheduled prior to discharge Um! They did have two of those. Obviously they should have been scheduled prior to being discharged. Um, that counts for ten 94 00:15:08.040 --> 00:15:19.040 Christopher Henry: inappropriate long time between discharge and first follow up appointment with a provider. There was one case of those so basically follow up appointments accounts for about fifteen of the case. 95 00:15:23.700 --> 00:15:26.730 Christopher Henry: So they did break down Um, the earlier 96 00:15:26.780 --> 00:15:45.130 Christopher Henry: uh talking points that we talked about patient uh misunderstanding uh the discharge instructions or regiment that counted for twenty-five. So there uh needs to really be a focus on that. Uh, at any time that we're talking with our patients. 97 00:15:45.140 --> 00:16:01.289 Christopher Henry: Um! But certainly during the pandemic there's been much confusion amongst uh the general population and even health care. So we need to make sure that patients have a complete understanding, or caregivers have a complete understanding of uh their medical 98 00:16:01.300 --> 00:16:05.310 Christopher Henry: medical regime whenever they go home, or to another facility, 99 00:16:06.330 --> 00:16:14.399 Christopher Henry: errors, and discharge orders hopefully that would not occur on a regular basis. But they did have to, so that counted for ten percent of that 100 00:16:14.790 --> 00:16:26.779 Christopher Henry: um. The inability to manage medications at home, whether it was to be able to fill them or understand the instructions they. They only had one case which accounted for five. 101 00:16:31.430 --> 00:16:38.489 Christopher Henry: So once again we're going to look at some more things that could uh cases, or that they found out of the cases that they studied 102 00:16:38.880 --> 00:16:45.700 Christopher Henry: uh, dis discharged home without a procedure required. Uh, 103 00:16:45.760 --> 00:16:54.460 Christopher Henry: hopefully, you know, only one of those was not directly related to the pandemic, and only two were so. Um, we got a fifteen percent uh 104 00:16:55.120 --> 00:17:03.329 Christopher Henry: percent of patients here that did not get something scheduled or received inadequate care or discharge 105 00:17:04.000 --> 00:17:11.859 Christopher Henry: inadequate treatment and medical condition during the index submission. Um! So other than pain. 106 00:17:11.890 --> 00:17:19.100 Christopher Henry: Uh, so whatever issue they were still having was still present, they were discharged. Anyways, of course, 107 00:17:19.119 --> 00:17:23.720 Christopher Henry: like I said, I understand part of that is simply because of the fact that 108 00:17:23.780 --> 00:17:35.149 Christopher Henry: we had uh overwhelmed hospitals, and I'm sure decisions had to be made uh for patients to be uh sent out before. Maybe they're ready to be discharged 109 00:17:35.990 --> 00:17:44.560 Christopher Henry: missing the diagnosis during that mission. Um! There was one of those, so they didn't catch the Covid while the patient was there they caught it on, readmission 110 00:17:46.180 --> 00:17:54.110 Christopher Henry: uh patient lacked awareness of whom to contact one to go, and when not to go the er uh once again 111 00:17:54.370 --> 00:17:57.060 Christopher Henry: our hospitals were pretty stressed out 112 00:17:57.330 --> 00:18:14.269 Christopher Henry: uh i'm sure we probably as healthcare officials didn't do it as good a job as we should have as educated in the public as to when to go to the er when it was best to stay home. Um! So there was two patients there accounting for ten percent 113 00:18:14.300 --> 00:18:16.899 Christopher Henry: patient or family had difficulty manage 114 00:18:17.030 --> 00:18:23.999 Christopher Henry: their self-care activities at home. Patient lacked awareness of follow up appointments or discharge planning again. 115 00:18:24.120 --> 00:18:28.930 Christopher Henry: Patient had family. Our family had difficulty managing symptoms at home. 116 00:18:29.370 --> 00:18:41.559 Christopher Henry: There was only one of those uh which i'm kind of surprised, uh considering that they had to er revisits, and only one patient was unable to manage their symptoms at home 117 00:18:44.410 --> 00:18:54.389 Christopher Henry: uh the patient requiring additional or different home services, and those included in discharge. Plans for a patient was not able to access services at home 118 00:18:55.320 --> 00:19:02.460 Christopher Henry: or patient required additional help for patients uh family caregivers, friends that was not available or sufficient, 119 00:19:02.990 --> 00:19:09.209 Christopher Henry: so the total of those four uh would be four patients or twenty of the cases. 120 00:19:09.610 --> 00:19:10.480 Um! 121 00:19:12.380 --> 00:19:22.030 Christopher Henry: The team do not relay important information to the primary care provider, outpatient providers patient. They are properly sent from subicute facility to the er 122 00:19:22.470 --> 00:19:26.819 Christopher Henry: the lack of disease, monitoring, for example, following daily weights. 123 00:19:26.870 --> 00:19:32.180 Christopher Henry: So once again there's been a common theme throughout this entire study, 124 00:19:32.220 --> 00:19:37.770 Christopher Henry: and most of that has been the lack of health, care professionals 125 00:19:37.810 --> 00:19:50.210 Christopher Henry: uh to assure that uh follow up care for understanding of their follow up. Care was in place prior to a patient being discharged. 126 00:19:50.220 --> 00:20:05.089 Christopher Henry: Um, like, I said. I understand that uh all facilities were overwhelmed at this time. Uh, we didn't have a lot of guidance as to how to proceed, and unfortunately we learned some major lessons from the pandemic, 127 00:20:05.100 --> 00:20:20.469 Christopher Henry: and hopefully, if that's one of those things it is that we do need to make sure we are following up with our patients, and making sure that um discharge instructions are totally complete and discharge arrangements are totally complete prior to discharge 128 00:20:22.690 --> 00:20:28.299 Christopher Henry: so some interventions that may have helped prevent the revisits 129 00:20:28.350 --> 00:20:32.440 Christopher Henry: so improve self management plan at discharge. 130 00:20:32.940 --> 00:20:49.859 Christopher Henry: Uh making sure that the patient's own it's in the own patient language that they um understand the discharge instructions. Uh, we don't have a lot of Hispanic uh population in West Virginia a little bit more so in the Pennsylvania area. 131 00:20:50.380 --> 00:20:56.419 Christopher Henry: Um, but we want to make sure that they totally understand uh discharge instructions. As we've said, 132 00:20:56.930 --> 00:21:03.489 Christopher Henry: You also want to clarify, clarify the timeliness of discharge. To make sure it is correct 133 00:21:03.590 --> 00:21:09.549 Christopher Henry: a time to discharge that patient. But, like I said, we know 134 00:21:09.630 --> 00:21:22.840 Christopher Henry: from uh lessons, learned that the hospital systems were not ready to cope with the amount of patients that we had an influx of um so hopefully moving forward in the future will be more prepared for that 135 00:21:24.150 --> 00:21:36.210 Christopher Henry: more complete communication. Um of discharge, instructions and documentation, for example, you know, making sure the patient knows exactly when and where they are to follow up with somebody 136 00:21:36.220 --> 00:21:45.020 Christopher Henry: when and where they need to go if they're having symptoms, or who they could call before having to go to an emergency room or to the hospital, 137 00:21:46.340 --> 00:21:51.930 Christopher Henry: improved a physician team recognition of patient symptoms. 138 00:21:52.850 --> 00:22:03.450 Christopher Henry: I once again tie that to the overwhelmingness of number of patients that you know influx into hospitals. Um into other facilities, 139 00:22:03.650 --> 00:22:11.510 Christopher Henry: but moving forward hopefully, we will pay a closer attention to the symptoms that a patient is experiencing, 140 00:22:12.790 --> 00:22:28.759 Christopher Henry: improve coordination between inpatient, outpatient providers, making sure that primary care. Provider is aware of what's going on with our patients um prior to discharge, and to make sure that team members or family members 141 00:22:28.770 --> 00:22:33.900 Christopher Henry: can take those patients to their follow-up appointments at that primary care. Facility, 142 00:22:35.340 --> 00:22:50.949 Christopher Henry: uh, and course all of that includes improved discharge planning, making sure the appointments are available. Um, that the patient is scheduled for them prior to the discharge that they have a way to get to the the Uh. Follow up appointment. 143 00:22:53.410 --> 00:23:07.960 Christopher Henry: Some more interventions would be to improve attention to medic medication safety uh making sure that they're able to fill their prescriptions. I know social determines is a big issue. Um, facing our 144 00:23:08.120 --> 00:23:13.450 Christopher Henry: population, and making sure that that patient can fill their medications, 145 00:23:13.750 --> 00:23:18.009 Christopher Henry: if not, have a social worker consult, put in place 146 00:23:19.000 --> 00:23:35.889 Christopher Henry: provision of resources to manage their symptoms after discharge. Make sure that if they, you know, are having issues with uh breeding, that they have oxygen in place, if they need that greater engagement of home and community support. Um use of 147 00:23:35.950 --> 00:23:37.010 um 148 00:23:37.060 --> 00:23:39.340 Christopher Henry: meals on wheels and other 149 00:23:39.400 --> 00:23:52.430 Christopher Henry: uh social programs. Obviously, I know when Covid hit it hit a lot of these services very hard, because we were no longer able to go into homes freely is like we could. 150 00:23:52.440 --> 00:24:10.170 Christopher Henry: But there are still some things in place that we could utilize. Uh, certainly moving forward. Now that a lot of the mass mandate uh social distancing has been lifted, we certainly need to utilize those social uh benefits that are out there in the community, 151 00:24:11.300 --> 00:24:26.010 Christopher Henry: financial insurance or transportation assistance. Um, That is obviously an issue that's hard to manage. But certainly a social work consult is needed, although in this particular study there was none. That's great 152 00:24:27.190 --> 00:24:36.169 Christopher Henry: An improved um discharge planning um of your advanced care. Planning is also mentioned. You want to have that in place as well. 153 00:24:36.640 --> 00:24:43.360 Christopher Henry: Um! There were a lot of issues with that when patients were emitted into the hospital, 154 00:24:44.610 --> 00:24:52.330 Christopher Henry: so let's look at the uh top reasons for we admission um particularly in West Virginia, and then we'll get to pennsylvania 155 00:24:52.450 --> 00:24:53.440 Christopher Henry: um 156 00:24:54.070 --> 00:24:59.679 Christopher Henry: a thousand and seventy-seven accounted for covid nineteen symptoms, 157 00:25:00.720 --> 00:25:18.460 Christopher Henry: bacterial infections in septicemia, which, of course, was probably presented in uh from the hospital itself. Uh is quite a bit of those over half the number of um Covid emissions, Covid. Nineteen, 158 00:25:18.690 --> 00:25:22.049 Christopher Henry: of course. Respiratory failure we would expect to see 159 00:25:22.560 --> 00:25:30.050 Christopher Henry: surprisingly renal failure was on there. Um! They have not been able to figure out for sure. Why, that is occurring. 160 00:25:30.920 --> 00:25:31.960 Christopher Henry: Um. 161 00:25:32.710 --> 00:25:36.880 Christopher Henry: But there was increased kidney uh 162 00:25:36.930 --> 00:25:41.839 Christopher Henry: damage done whenever patients had severe cases of Covid. 163 00:25:42.450 --> 00:25:47.049 Christopher Henry: Of course, pulmonary symbolism was fifth for West Virginia 164 00:25:47.120 --> 00:25:56.170 Christopher Henry: and chronic kidney disease. Of course we would expect to see that again, since it is one of the side effects of Covid 165 00:25:56.480 --> 00:26:05.639 Christopher Henry: uh gastrointestinal issues credit just r me at fluid electrolytes. So a large portion of the top five 166 00:26:10.500 --> 00:26:11.630 Christopher Henry: um 167 00:26:12.860 --> 00:26:18.030 Christopher Henry: uh diagnosis for West Virginia are almost the same as they are for 168 00:26:18.110 --> 00:26:20.399 Christopher Henry: Pennsylvania oops. Sorry 169 00:26:21.080 --> 00:26:26.900 Christopher Henry: exactly almost exactly the same. Um Covid nineteen uh thousand 170 00:26:26.990 --> 00:26:38.850 Christopher Henry: and seventy-seven cases. Every admissions based on the symptoms of Covid uh once again over five hundred, some uh related deception and bacterial infections. 171 00:26:38.900 --> 00:26:58.390 Christopher Henry: Respite, Respiratory failure again is third and um. The renal failure is in fourth and pulmonary embolism. Um and guess testimonial issues so almost exactly the same as West Virginia. So a lot of the over half of the 172 00:26:58.400 --> 00:27:09.780 Christopher Henry: diagnosis we're related to it strictly to Covid nineteen, whereas the others were the close uh second were usually respiratory issues or bacterial infections, 173 00:27:12.940 --> 00:27:30.789 Christopher Henry: so best practices to avoid um discharge. Um i'm sorry. Avoid re-emissions is discharge transitions. As we talked about before making sure the patients totally understand what is uh expected of them. Make sure everything's in place 174 00:27:30.800 --> 00:27:40.170 Christopher Henry: prior to discharge primary uh care follow ups all those appointments uh transportation, language, barrier issues, all need to be addressed. 175 00:27:40.470 --> 00:27:46.990 Christopher Henry: You determine whether the patient is linked to a primary care provider, and make sure that's taken care of, 176 00:27:47.290 --> 00:27:52.910 Christopher Henry: and that you have any interpreter type services in place for people that um 177 00:27:53.400 --> 00:28:03.889 Christopher Henry: do not speak English as their primary language, and of course, as we know, you want fifth grade, or lower on your discharge instructions so that people can comprehend them easily. 178 00:28:06.590 --> 00:28:14.810 Christopher Henry: You want to avoid medical jargon whenever you're discussing, uh, follow up care or discharge instructions with that patient. 179 00:28:15.200 --> 00:28:22.960 Christopher Henry: You want con um cultural, like um components of care also to be considered into the um 180 00:28:23.270 --> 00:28:28.160 Christopher Henry: patients discharge and understanding and discharge instructions. 181 00:28:28.350 --> 00:28:35.730 Christopher Henry: Um, so that they can can incorporate their cultural beliefs and promote self family support into that. 182 00:28:36.310 --> 00:28:51.120 Christopher Henry: Of course we talked about social determinants of help. That will always be an issue. Uh, you want to make sure there's housing and food and transportation if needed, or try to encourage that um some other way to get that completed through community support. 183 00:28:52.530 --> 00:29:11.659 Christopher Henry: You want to also make sure, uh since they have co-orbidities and sure appropriate. Excuse me, appropriate referral to uh for their comorbidities that may be involved. Um, maybe a diabetes program if that's um something that uh the patient needs to system. 184 00:29:15.040 --> 00:29:18.879 Christopher Henry: I hope you enjoyed the presentation. Um, I um 185 00:29:20.210 --> 00:29:28.969 Christopher Henry: like, I said. I do apologize. The fact that we do not have any information from Cdc and Cms. From two thousand and twenty-two numbers. Um! 186 00:29:29.030 --> 00:29:43.800 Christopher Henry: But we have gone down to about a thousand to five thousand emissions a day uh Covid admissions a day. It's been on a steady decline, and hopefully, this new amicron uh booster will also help with that as Well, 187 00:29:44.070 --> 00:29:45.150 Christopher Henry: um! 188 00:29:45.510 --> 00:29:55.040 Christopher Henry: But certainly there are takeaways from this that we can show um in future endeavors, even if not with Covid itself. It's still 189 00:29:55.330 --> 00:30:01.479 Christopher Henry: that once again patient education and discharge is one of the major um 190 00:30:02.700 --> 00:30:10.089 Christopher Henry: major factors, and contributing to re-emissions so that's something we need to really concentrate on moving forward 191 00:30:10.530 --> 00:30:29.740 Christopher Henry: We uh do have a new flyer quality insights addressing Flu and Covid uh vaccinations being given together. If anyone would like that information, I have my email up here for you. You can contact me, and i'll be happy to send that to you. You can use a lot, utilize it as a patient handout, 192 00:30:29.750 --> 00:30:34.670 Christopher Henry: educational flyer or as a post-stringer in your clinics. 193 00:30:35.410 --> 00:30:39.039 Christopher Henry: Are there any uh questions? Sorry. 194 00:30:39.820 --> 00:30:43.439 Christopher Henry: Does anybody have any questions you can put them in the chat box? 195 00:30:45.840 --> 00:30:50.379 Quality Insights: Yeah, please go ahead and feel free to answer those now into the chat or the Q. A. 196 00:30:51.470 --> 00:31:06.000 Quality Insights: And I just also wanted to remind everybody that a recording of the Webinar, as well as the slides, will be posted on our website. And um, i'm gonna go ahead and put the link to that where those will be posted in the chat, so that you all have that handy, 197 00:31:06.660 --> 00:31:10.430 Quality Insights: and I will also post uh in the chat 198 00:31:10.880 --> 00:31:21.130 Quality Insights: as well a link to the evaluation. Just wanted to remind everyone to please complete the evaluation at the end of the Webinar and I'll put a link to that while we're waiting for any additional questions. 199 00:31:31.460 --> 00:31:36.120 Quality Insights: We do have someone saying very informational, Webinar. Thank you, Chris. 200 00:31:36.720 --> 00:31:38.159 Christopher Henry: Thank you very much. 201 00:31:39.480 --> 00:31:41.459 Quality Insights: Great information. 202 00:31:41.490 --> 00:31:45.500 Quality Insights: Couple of not so much questions, but compliments. 203 00:31:53.900 --> 00:32:12.920 Christopher Henry: All right, everybody. Well, thank you for attending today. I hope you uh learn some information and um enjoy the Webinar, and we hope to hear from you soon. If there's ever any topic you would like for us to address with you. Please share that, and we look forward to seeing you at one of our new next and upcoming Webinars. 204 00:32:12.930 --> 00:32:14.269 Christopher Henry: You all have a great day. 205 00:32:14.710 --> 00:32:16.170 Quality Insights: Thanks, everybody.