Christopher Henry: This meeting is being recorded.
Okay?
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.
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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.
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.
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.
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.
Christopher Henry: Thank you.
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.
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.
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
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.
Christopher Henry: I will preface this presentation and the fact that,
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
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,
Christopher Henry: so the most information I can present.
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,
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
Christopher Henry: the year
Christopher Henry: uh the Cdc says basically one in eleven, hey? Uh peak patients will be re hospitalized that we're diagnosed
Christopher Henry: with Covid nineteen initially.
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.
Christopher Henry: Uh, if they had had host uh had Covid nineteen prior to their admission,
Christopher Henry: or if they've been discharged to a skilled nursing facility or home health care.
Christopher Henry: So when I looked at the Cdc. Numbers um
Christopher Henry: during uh the times of March through July of two thousand and twenty, fifteen percent died Um! During the study
Christopher Henry: and about eighty-five percent survived. Nine of those were re-admitted the same hospital within two months of discharge.
Christopher Henry: So
Christopher Henry: that is close to that Cdc. Number of eleven. Of course there's variant from state to state
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
Christopher Henry: re-emissions occur more often amongst patients that were sent to skilled nursing facilities, probably because the close proximity
Christopher Henry: of each resident
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
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
Christopher Henry: whoops. Sorry
Christopher Henry: the Cdc. Also said the Um. Possible re emissions increase with age among people sixty, five in order. As we talked about
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
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,
Christopher Henry: with a benchmark or a low mark of eight point. Four was the lowest we'd seen in any of the counties,
Christopher Henry: so there was five hundred and eighty-three
Christopher Henry: uh admissions. I'm sorry we had uh patients that were diagnosed, and discharged with Covid
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.
Christopher Henry: I'm: Sorry. Yeah, twenty,
Christopher Henry: eleven, twenty, twenty through ten, thirty, one of twenty, one
Christopher Henry: year. Um as far as Pennsylvania.
Christopher Henry: They also are almost exactly the same in numbers. Fifteen point nine readmission rate,
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,
Christopher Henry: and the best at the county ever did in Pennsylvania was eight point, two percent re-emission rate.
Christopher Henry: So when we talked about age being an issue.
Christopher Henry: Um comorbidities also is an issue among those hospitalized with Covid nineteen, the remitted higher um burden of comorbidities than non
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.
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.
Christopher Henry: Um. So
Christopher Henry: once again. We'll talk about those reasons as we get further into the webinar
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.
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,
Christopher Henry: and some people are at increased risk of getting very sick or dying from Covid because of where they live or work,
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.
Christopher Henry: This includes many people from racial and ethnic minorities, and people with the disability.
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
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,
Christopher Henry: and more likely to get Covid nineteen and have worse outcomes than like I, said the other populations.
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.
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
Christopher Henry: and twenty-one had ed visits without a mission, fifty-five readmissions
Christopher Henry: the media number of days to revisit was
Christopher Henry: um three to eighteen
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.
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
Christopher Henry: inappropriate choice of a discharge location,
Christopher Henry: including, uh sending them to a congregate or skilled nursing facility, where there is close proximity of
Christopher Henry: of uh
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
Christopher Henry: uh such a long time ago, but such a short time ago, at one point in time.
Christopher Henry: In January of this year we were having a hundred and forty-five thousand emissions a day with Covid.
Christopher Henry: Uh, thank God! That number has been decreasing over the last several months.
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,
Christopher Henry: and the newer strains have not seemed to have caused um as much hospital admissions.
Christopher Henry: Also, another significant factor for re-admission was discharged without needed procedures uh being kept
Christopher Henry: and patients being discharged too soon. Obviously our. We
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.
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.
Christopher Henry: So um, according to the study.
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,
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.
Christopher Henry: So the inappropriate choice of discharge, for example, skilled missing versus home
Christopher Henry: um or
Christopher Henry: another facility. Only one of those was directly related to the,
Christopher Henry: to the pandemic itself. Only four were not for only five or twenty five percent of the cases
Christopher Henry: patients just charge you soon
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
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.
Christopher Henry: So they did break down Um, the earlier
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.
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
Christopher Henry: medical regime whenever they go home, or to another facility,
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
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.
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
Christopher Henry: uh, dis discharged home without a procedure required. Uh,
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
Christopher Henry: percent of patients here that did not get something scheduled or received inadequate care or discharge
Christopher Henry: inadequate treatment and medical condition during the index submission. Um! So other than pain.
Christopher Henry: Uh, so whatever issue they were still having was still present, they were discharged. Anyways, of course,
Christopher Henry: like I said, I understand part of that is simply because of the fact that
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
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
Christopher Henry: uh patient lacked awareness of whom to contact one to go, and when not to go the er uh once again
Christopher Henry: our hospitals were pretty stressed out
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
Christopher Henry: patient or family had difficulty manage
Christopher Henry: their self-care activities at home. Patient lacked awareness of follow up appointments or discharge planning again.
Christopher Henry: Patient had family. Our family had difficulty managing symptoms at home.
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
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
Christopher Henry: or patient required additional help for patients uh family caregivers, friends that was not available or sufficient,
Christopher Henry: so the total of those four uh would be four patients or twenty of the cases.
Um!
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
Christopher Henry: the lack of disease, monitoring, for example, following daily weights.
Christopher Henry: So once again there's been a common theme throughout this entire study,
Christopher Henry: and most of that has been the lack of health, care professionals
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.
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,
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
Christopher Henry: so some interventions that may have helped prevent the revisits
Christopher Henry: so improve self management plan at discharge.
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.
Christopher Henry: Um, but we want to make sure that they totally understand uh discharge instructions. As we've said,
Christopher Henry: You also want to clarify, clarify the timeliness of discharge. To make sure it is correct
Christopher Henry: a time to discharge that patient. But, like I said, we know
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
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
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,
Christopher Henry: improved a physician team recognition of patient symptoms.
Christopher Henry: I once again tie that to the overwhelmingness of number of patients that you know influx into hospitals. Um into other facilities,
Christopher Henry: but moving forward hopefully, we will pay a closer attention to the symptoms that a patient is experiencing,
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
Christopher Henry: can take those patients to their follow-up appointments at that primary care. Facility,
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.
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
Christopher Henry: population, and making sure that that patient can fill their medications,
Christopher Henry: if not, have a social worker consult, put in place
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
um
Christopher Henry: meals on wheels and other
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.
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,
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
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.
Christopher Henry: Um! There were a lot of issues with that when patients were emitted into the hospital,
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
Christopher Henry: um
Christopher Henry: a thousand and seventy-seven accounted for covid nineteen symptoms,
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,
Christopher Henry: of course. Respiratory failure we would expect to see
Christopher Henry: surprisingly renal failure was on there. Um! They have not been able to figure out for sure. Why, that is occurring.
Christopher Henry: Um.
Christopher Henry: But there was increased kidney uh
Christopher Henry: damage done whenever patients had severe cases of Covid.
Christopher Henry: Of course, pulmonary symbolism was fifth for West Virginia
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
Christopher Henry: uh gastrointestinal issues credit just r me at fluid electrolytes. So a large portion of the top five
Christopher Henry: um
Christopher Henry: uh diagnosis for West Virginia are almost the same as they are for
Christopher Henry: Pennsylvania oops. Sorry
Christopher Henry: exactly almost exactly the same. Um Covid nineteen uh thousand
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.
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
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,
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
Christopher Henry: prior to discharge primary uh care follow ups all those appointments uh transportation, language, barrier issues, all need to be addressed.
Christopher Henry: You determine whether the patient is linked to a primary care provider, and make sure that's taken care of,
Christopher Henry: and that you have any interpreter type services in place for people that um
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.
Christopher Henry: You want to avoid medical jargon whenever you're discussing, uh, follow up care or discharge instructions with that patient.
Christopher Henry: You want con um cultural, like um components of care also to be considered into the um
Christopher Henry: patients discharge and understanding and discharge instructions.
Christopher Henry: Um, so that they can can incorporate their cultural beliefs and promote self family support into that.
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.
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.
Christopher Henry: I hope you enjoyed the presentation. Um, I um
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!
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,
Christopher Henry: um!
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
Christopher Henry: that once again patient education and discharge is one of the major um
Christopher Henry: major factors, and contributing to re-emissions so that's something we need to really concentrate on moving forward
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,
Christopher Henry: educational flyer or as a post-stringer in your clinics.
Christopher Henry: Are there any uh questions? Sorry.
Christopher Henry: Does anybody have any questions you can put them in the chat box?
Quality Insights: Yeah, please go ahead and feel free to answer those now into the chat or the Q. A.
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,
Quality Insights: and I will also post uh in the chat
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.
Quality Insights: We do have someone saying very informational, Webinar. Thank you, Chris.
Christopher Henry: Thank you very much.
Quality Insights: Great information.
Quality Insights: Couple of not so much questions, but compliments.
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.
Christopher Henry: You all have a great day.
Quality Insights: Thanks, everybody.