CoxHealth is a five-hospital system in Southwest Missouri, USA. It has a total of 992 beds with more than 237,000 ED/Urgent Care visits per year and serves a primarily rural population.
Readmission of patients within 30 days of discharge is one of the most serious issues plaguing healthcare delivery in the United States. As part of the Affordable Care Act, in 2012 the Medicare program began withholding small proportions of payments to hospitals if patient readmissions occured due to certain medical conditions.
To reduce hospital readmissions, CoxHealth embarked on a variety of initiatives to reduce the likelihood that patients would be readmitted. It integrated a tool into its electronic medical records system that gauged the risk of readmission for each patient, based on factors such as whether they had been hospitalized before and the number of prescription medications they were taking, among others. It also put a care redesign team into place to study how it might be able to change processes that while familiar, might not represent the best clinical pathways for patients.
Another initiative undertaken was paying closer attention to patients as they were being discharged. A team was assembled to contact patients immediately after being discharged to closely coordinate their care, including the use of home healthcare services.
CoxHealth paid particular attention to patients who had five or more hospital admissions through the emergency room, a cohort that tends to have a significantly higher readmission rate than average.
CoxHealth chose DNV GL as its accrediting body in March 2015. Although the system had been planning a readmission reduction program before contracting with DNV GL, its presence as the new accreditor helped put the process in motion.
Reduced patient readmissions
Healthcare accreditation and ISO 9001 helped align the organizational strategy, reducing patient readmission.
As a result of the initiative, there was a 16 percent decrease in the total ED visits of the inclusive population. Returns to the ED within 72 hours decreased by 20 percent. More than 10,000 care hours opened up in the ED, which allowed increased access for 3,400 acute emergent patients. CHAPP enrollee ED visits decreased by 97 percent during the 12 week enrollment. There was also an 89 percent decrease in the number of ambulance transports to the hospital during program enrollment. This increased ambulance availability for 119 emergent responses.
Arlo Stallion, CoxHealth's System Director of Regulatory Affairs and Medical Staff Services, noted the DNV GL partnership and ISO 9001 process approach supports and creates greater synergy to undertake these initiatives.
"The NIAHO accreditation and ISO 9001 process approach helps us be more efficient and effective in the use of our resources," she said, adding that the collaborative patient centered approach to accreditation "promotes and fosters better communication and effective process redesign."
"Moreover, the use of the ISO 9001 standard is aligning key processes and enabling further integration and standardization across CoxHealth," Stallion said.
Stallion observed that the presence of DNV GL has helped it change the way it addresses clinical issues.
"It is changing our attitude and approach to continual improvement," she said.