EP6EO

 

Interprofessional Care EP6EO

 

1. Provide one example, with supporting evidence, of an improvement in a defined patient population outcome associated with nurse participation in an interprofessional collaborative plan of care.
   • Patient outcome data must be in the form of a graph with a timeline data table.

 

 

Example: Nurse Participation in an Interprofessional Collaborative Plan of Care Increases Total Knee Replacement Patients Discharged to Home

Problem
Greenwich Hospital’s interprofessional Total Joint and Spine Steering Committee includes nurses, surgeons, physical therapists, case managers, anesthesiologists and surgical service line leadership. The committee meets monthly to review data on patient volume, length of stay, discharge disposition and Joint Commission metrics. The Total Joint and Spine Steering Committee evaluated existing discharge practices and found that in 4th Quarter 2016 only 16.5% of total knee replacement patients were discharged to home post-operatively rather than a skilled nursing facility. Evidence demonstrates that patients who are discharged to home rather than to a skilled nursing facility have better outcomes in terms of healing, infection rates and functional mobility. 

 

Goal Statement
Increase percentage of total knee replacement patients that are discharged to home post-operatively.

 

Participants

 

Total Joint and Spine Steering Committee
Name/Credentials	Discipline	Title/Role	Department
Ann Nardi, DPT, PT	Physical Therapist	Coordinator of the Total Joint Replacement Program	Surgery Unit
Sheila Finn, MSN, RN	Nursing	Clinical Coordinator, Clinical Nurse	Surgery Unit
Kasey Connor, MSN, RN, OCN	Nursing	Clinical Nurse, Clinical Resource Nurse	Surgery unit
Peggy Lennon, MSN, RN, NE-BC	Nursing	Program Director	Surgical Services
Marie Pham, BSN, RN, AORN	Nursing	Manager	Operating Room
Patricia Babcock, BSN, RN	Nursing	Director	Case Management
Helene Kimmons, BSN, RN, CAPA	Nursing	Manager	Ambulatory Surgery and PACU
Carolyn Bender, BSN, RN, CIC	Nursing	Infection Preventionist	Infection Control
Jessie Riemer, MSN, RN, CPHQ	Nursing	Senior Performance Management Specialist	Performance Management
Margaret Dorrance, RN	Nursing	Nurse Case Manager	Case Management
Marcelle Husband, BSN, RN	Nursing	Nurse Case Manager	Case Management
Rebecca Boutsikoudis, LCSW	Social Work	Social Worker Case Manager	Case Management
Brian Kavanagh, MD	Orthopedic Surgeon	Medical Director, Total Joint Replacement Program	Orthopedics
Thomas Milucci, DPT, PT	Physical Therapist	Director	Physical Medicine
Julie Wahnish, PT, DPT	Physical Therapist	Inpatient Coordinator	Physical Medicine
Jaclyn Kito, PT, DPT	Physical Therapist	Physical Therapist	Physical Medicine
Mark Chrostowski, MD	Anesthesiologist	Anesthesiologist	Anesthesia

 

Description of the Intervention
1st Quarter 2017-3rd Quarter 2018
The interprofessional members of the Total Joint and Spine Steering Committee conducted a literature review to identify best practices for safe discharge for the total knee patient population. The committee identified that the literature supported discharge to home as a safe discharge plan with effective preoperative assessments and patient education. Based on the committee members’ review and discussion, they identified the need to develop an interprofessional discharge planning assessment tool. The tool would provide valuable assessment data to incorporate an interprofessional collaborative plan of care for discharge for the total knee population, incorporating an assessment of the patients’ home setting as well as physical, medical and social needs.

 

The discharge tool is used to evaluate whether the patient can be discharged home or requires discharge to a rehab facility. If the patient has optimal cognitive functioning and an optimal environment at home – no more than two steps into the home dwelling and a caretaker available to provide support and assistance – then the patient is to plan for home discharge. If the patient has functional decline, more than two stairs at home and no caregiver, they are set up for rehab placement. The intent was for patients to complete the discharge tool preoperatively, with the interprofessional team then using the information collected to facilitate a safe discharge plan. The tool assists the nurse and interprofessional team to collaboratively prepare a safe patient discharge.

 

Trial of the Discharge Planning Assessment Tool
The Total Joint and Spine Steering Committee agreed to conduct a trial of the new discharge planning assessment tool. Ann Nardi, DPT, PT, Coordinator of the Total Joint Replacement Program, and Kasey Connor, MSN, RN, Clinical Nurse, Clinical Resource Nurse teach the Preoperative Total Knee class. During the trial, they began educating patients and caregivers on completing the tool. Options for a safe discharge, including discharge to home, were incorporated into to the education.

 

Nardi and Connor collected and analyzed the data from the trial. The Total Joint and Spine Steering Committee reviewed the data and evaluated the effectiveness of the tool by monitoring the following monthly: accuracy of the discharge planning assessment tool and the percentage of total knee patients discharged to home rather than to a rehab facility based on the score of the tool.  

 

Based on the data gathered from the trial, the Total Joint and Spine Steering Committee revised the tool to make it more specific and to include in the preoperative assessment the measure of independence with activities of daily living (ADL). The revised tool included questions about ADLs, bathing, dressing, preparing meals and level of activity.

 

All interventions were fully implemented by the end of 3rd Quarter 2018.

 

Outcomes
Nurse participation in an interprofessional collaborative plan of care for total knee replacement patients led to an improved patient outcome.

 

In the three quarters following implementation, the percentage of total knee replacement patients discharged home increased to 59.6% in 4th Quarter 2018, 59.3% in 1st Quarter 2019 and 64% in 2nd Quarter 2019.

 

 

Evidence EP6EO-1, Greenwich Hospital Percentage of Total Knee Replacement Patients Discharged to Home Post-operatively