Excellent Care for All

Reducing 30-day readmissions – Tackling a key indicator of Quality Improvement Plans at the Trillium Health Centre

Health Care Challenge

Unplanned hospital readmissions exact a toll on individuals, families and the health system. Yet, in 2009, there were 140,000 unplanned cases of patients readmitted to hospitals in Ontario within 30 days of their original discharge.

Avoidable readmissions remain a system-level issue that is also linked to integration among providers across the continuum of care.  If patients get the care they need when and where they need it, this can help to reduce the number of preventable hospital readmissions.

Real Change In Action

Trillium Health Centre in Mississauga has achieved one of the lowest readmissions rates in the province.

The Excellent Care for All Act requires all Ontario hospitals to develop a quality improvement plan (QIP). While Trillium has had a Board Quality Monitoring Committee in place since 2007, ECFA presented an opportunity to critically review the hospital’s processes.

In an effort to improve its readmission rates even further, as part of its QIP, Trillium identified reducing its 30-day readmission rates as “priority one”. The hospital set a goal of reducing readmissions to 11.5 percent for the 2011-12 fiscal year.

Despite earlier achievements, the QIP focused added attention on readmissions because of the hospital staff’s unwavering commitment to continuous improvement and their understanding of the profound and positive impact that avoiding unnecessary hospitalizations has on patients.

“Trillium faces many of the same challenges as other hospitals in the province and some challenges that are specific to our community,” said Janet Davidson, O.C., President and Chief Executive Officer, Trillium Health Centre. “We have a large and diverse seniors community. We have high volumes, acuity and complexity of patients admitted to our hospital. So, it has been really important to look at readmissions from multiple angles and examine the care along the continuum.”

The hospital formed a project team and the readmission literature was reviewed.  “All of Trillium’s relevant projects, programs and historical strategic investments were catalogued to better understand how Trillium was able to establish its current status as a provincial leader on reducing readmissions,” explained Dr. Amir Ginzburg, Physician Director, Patient Safety and Quality. 

The hospital’s team then identified further opportunities for improvement in readmission rates and developed an organizational strategy to look at root causes of avoidable re-admissions and to develop and deploy solutions.

The project team catalogued four major drivers to further reduce readmissions:

The hospital created a driver diagram to outline past work, current projects and future directions.  Supported by senior management and the board, and driven by the QIP, Trillium implemented several changes very quickly and aligned this work with its strategic priorities.

“Identifying at-risk patients is a critical enabler for staff to deploy limited pre- and post-discharge interventions to improve patient outcomes and prevent unplanned readmissions,” said Susan Bisaillon, Executive Director, Clinical Operations. 

In March 2011, Trillium implemented the LACE Index, an innovative scoring tool for determining a patient’s readmission risk.  The tool looks at a patient’s length of stay, acuity of the admission, comorbidities, and emergency room visits in the preceding six months.  Using LACE, Trillium’s team was able to correctly identify readmissions 85 percent of the time.

The hospital is currently working on automating LACE within Trillium’s electronic patient record with a goal of having index scores calculated on a daily basis, then feeding visual management cues to each ward’s electronic whiteboard. 

A high LACE score will trigger comprehensive interventions that Trillium hopes will further reduce its readmissions rate.  The first level of intervention will involve a care transition plan that provides enhanced inter-professional services both pre- and post-discharge for at-risk patients. 

The second level of intervention will offer a “Transitions Team” to provide enhanced assistance with case management, discharge planning, communication to community providers, patient activation, nurse-led coaching, patient education, and community outreach.  “While Trillium already has outreach programs supporting seniors care and other transition services, a Transitions Team will be able to leverage these in a coordinated fashion for vulnerable patients,” said Charlene Sandilands, Director, Cardiac Health System.

Patti Cochrane, Vice-President of Patient Services and Trillium’s Chief Nursing Officer, described the quality improvement project as a truly collaborative venture within the hospital. “It’s been an inspiring journey thanks to the joint and committed efforts of the clinical and administrative staff who worked on this project,” Cochrane said.

Better Quality, Sustainable Care

Trillium’s QIP has mobilized its staff to achieve continuous improvements in the area of avoidable readmissions. The hospital’s commitment will support the goal of delivering safe and high quality care to its patients.

Contact person :
Larry Roberts
Media Relations Advisor
Trillium Health Centre
Tel: 905-848-7580 ext. 3832

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