Team Led by Marty Sellers and Juan Sarmiento Wins 2017 EHC Quality Academy Poster Award
The poster competition at Emory Healthcare's 10th Annual Quality Conference on June 1st featured 35 finalists out of 135 entries competing for awards in nine different categories. Hepatobiliary surgeons Marty Sellers, MD, MPH, and Juan Sarmiento, MD, led the team that won the Outstanding Quality Improvement Intervention Award for an effort to reduce 30-day readmissions after hepatobiliary (HPB) surgery at Emory University Hospital (EUH).
Hospital readmission within 30 days is costly for patients and hospitals alike. While predictive factors for readmission after HPB surgery are generally known, and EUH's 30-day HPB readmission rate over the prior 30 months was a favorable 14% compared to the national average of 18%, Drs. Sellers and Sarmiento and their team suspected certain factors contributing to their readmission rate could be effectively targeted. Their goal was to reduce the readmission rate by 15% (to ≤12% 30-day readmissions). If they achieved this, they believed their methods could be applicable to other surgical disciplines.
The team started with examining data related to patients who underwent HPB surgery at EUH from January 1, 2014 through March 31, 2017. They then identified 30% of a random sample of readmissions as avoidable and enacted the following strategies to address their common factors:
- Had staff call patients on the third post-discharge day for assessment of any concerning symptoms and proactive intervention.
- Upon discharge, had an advanced practice provider (APP) reiterate the importance of nutrition, exercise, dependable family support structure, and awareness of the difference between the normal and the aberrant in post-op recovery as a supplement to the floor nursing staff's instructions.
- Added a clinic visit with an APP to patients' pre-op preparations to introduce the substance of the APP's discharge directives listed in #2.
- Instituted a one week post-discharge patient visit to the clinic for the APP to evaluate the patient's health status and identify and treat any potential issues that might otherwise lead to readmission.
The post-discharge phone call and APP-directed discharge education commenced in 2015, while actions #3 and #4 started in January 2017. Early results have been encouraging, and the team has already seen a >15% reduction in readmission rates, with six straight quarters having rates lower than the initial mean. Readmission rates in each of the first two quarters in 2017 was <10%.
"Since we started this effort, we have held biweekly meetings to review readmissions and to scrutinize the reasons behind them," says Dr. Sellers. "Understanding these reasons led to our original identification of modifiable factors, and we expect they will continue to lead to refinement of our protocols and further reduction of readmissions."
Dr. Sellers and Dr. Sarmiento's team members were Sebastian Perez, MSPH, Catherine Blair, PA-C, Lori Little, PA-C, Pauline Chandler, RN, Neha Sharma, MPH, and Joyce Jones, BS.