Building Best Practice To Reduce ACH

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Building Best PracticeTo Reduce ACH

• Cascade Home Health Hospice
• Eugene, Oregon
• August 21, 2007

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Cascade Home Health Hospice

• Affiliation of Cascade Health Solutions
• Freestanding nonprofit
• Service area 50-mile radius
• Software Suncoast Solutions
• Laptop point of care
• IPG 2 agency

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Cascade Home Health Hospice

• Home health staff
• 10 RNs
• 7 PTs (most are full time)
• 2 part time OTs SLPs
• 1 ½ MSW
• 3 Home health aides

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Cascade Leadership Team

• Judy Howe, RN, Manager Director
• Robin Whaley, PTA, QA Compliance
• Chris Veloon, RN, Rehab Manager
• Jackie Fowler, RN, Staff Development

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Oregon ACH RateGoal To Maintain 21 or Less
National Data Source STAR 12/06 Oregon Data
Source CASPER 4/07
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Cascades Multifaceted Leadership Best Practice
Strategies

• Clinical expertise
• Communication
• Staff education
• Relationship with physicians discharge planners

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Cascades Multifaceted Leadership Best Practice
Strategies (cont.)

• Telephone assessment guides
• Ongoing audits
• Zone tools
• Stay in front of changes in the medical community

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Clinical Expertise

• Geriatric
• Long-term care
• Home health hospice
• RNs dont panic
• ACH rates, emergent care episodes adverse
  events increase when new hires do not have same
  level of expertise

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Communication

• Assertive staff
• Notify management when more training needed
• Case conferences
• Leadership listens to staff
• Physician communication (see handout)

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Staff Education

• Just-in-time
• Weekly case conferences
• Ten-minute in-services as needed
• Weekly one-hour clinical training given by
  community experts

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Relationship with Physicians Discharge Planners

• Mutual respect with physicians
• Coach d/c planners on hospital rounds
• Reduction of inappropriate referrals
• Patients stay in hospital longer
• Hospital outcomes improve

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Telephone Assessment Guides

• Generic disease specific (see handouts)
• Staff post at their cubicles as reference
• Reference when making phone calls
• Do not increase paperwork

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Ongoing Audits Zone Tools

• Immediate feedback with audits
• Zone tools posted on patients refrigerators (see
  handouts)
• Agency phone number in several locations
  throughout the home

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Stay in Front of Changes in the Medical Community

• Keep informed of new trends, treatments, etc.
• Example Wound Vacs
• Had in-services booked for staff immediately

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Factors That Influence Success

• All staff come into the office each day
• Disciplines sit together in pods
• Staff insert time in their schedules for patient
  phone calls
• Small enough that trends can be addressed
  quickly, effectively, autonomously

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Questions??

• Thanks for the opportunity to meet with you today

This material was prepared by Acumentra Health,
Oregons Medicare Quality Improvement
Organization, under contract with the Centers for
Medicare Medicaid Services (CMS), an agency of
the U.S. Department of Health and Human Services.
The contents presented do not necessarily reflect
CMS policy. 8SOW-OR-HH-07-17 rev. 08-06-07