Medical Staff Newsletter Summer 2015

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MEDICAL STAFF

Newsletter 172 Kinsley Street

Nashua NH 03060

A Quarterly Newsletter published by the St. Joseph Healthcare Medical Staff Summer 2015

Early Mobilization in the Hospitalized Patient

As our general population ages, it becomes much more important for the medical field to

be more equipped with appropriately treating the elderly population in a hospitalized

environment. Often times, it takes patients many days of “not feeling well” before they

present to the hospital during an acute illness. Due to their generalized weakness and

feelings of malaise, patients sometimes opt to stay in bed for multiple days in the hopes

to recover from their illness. However, patients who remain in bed for prolonged periods

of time may develop additional preventable complications. These complications are often

times referred to as “deconditioning” and account for functional declines that are caused

by the patient’s inability to expand their lungs, strengthen their muscles or appropriately

care for themselves. Without the encouragement and support of the healthcare team,

patients may not completely understand the importance of early ambulation and

mobilization to help prevent deconditioning. ……………………………………….

The reasons for mobilizing patients early in their hospitalization are based upon the

physiological effects that bedrest may have on these patients. Though allowing periods of

rest for acutely ill patients is beneficial in their recovery, prolonged periods of immobility

may result in functional declines that impair their cognition, ADL performance and

physical fitness. These impairments may have lasting impressions on vulnerable

populations, such as the elderly population, that may impact their disposition upon

discharge. Though healthcare providers understand the importance of preventing

immobility in their patients, it is clear that hospitalized patients are still not being

mobilized as often as they should be. According to a study performed by So and

Pierluissi (2012) only 11% of elderly patients were asked to ambulate during their

hospitalization. Whether the reasons are based upon lack of time and assistance, patient

refusal, or assorted other difficulties, it is important to acknowledge the barriers that exist

and attempt to overcome them. …………………………………………………………….

In order to facilitate early mobilization in the hospitalized patient populations, extensive

education will be provided to not only the direct care givers, but also to the leadership,

interdisciplinary team members and patients. Staff education will be implemented to

provide the healthcare team with the resources and education needed to safely and

effectively mobilize their patients. Providing patients with knowledge about their plan of

care or disease processes will also allow patients to be more involved in decision making

which aids in promoting healthy habits, such as mobilization. …………………………..

Continued on page 2

Journey to ISO 9001

We have begun a new

approach to accreditation at

St. Joseph Hospital. The

survey team for DNV has

just left the hospital and we have successfully

completed the first limb of a 4 year journey to ISO

9001 certification. …………………………………..

DNV stands for Det Norske Veritas ("the Norwegian

Truth") and they are one of two deeming authorities

who survey for compliance to the Medicare

Conditions of Participation. You're probably more

acquainted with the other one--The Joint Commission.

But over the last several years, many healthcare

organizations have transitioned to DNV. We are the

fifth hospital in New Hampshire to do so.……………

ISO 9001 has greater recognition in industry than in

healthcare, but that is quickly changing. Hospitals

aspire to achieve this high standard of quality and

efficiency, and can attain certification after a

minimum of 4 years of progressive standards

achievement.

It’s readily apparent from the survey process that

there is considerable emphasis on standardization of

processes across the organization and a strong focus

on measurement and documentation. "Improve it"

and "prove it" are basic tenets. ……………………….

Unlike the Joint Commission, DNV will be back at

least annually. At the outset they've also adopted a

collaborative and educational approach, and

facilitated transparency and candor on the part of

staff, so the survey experience is decidedly different.

There is one consistent observation however. Our

staff and medical staff continue to impress surveyors.

I had the pleasure of actively participating in the

process the last 3 days and witnessing the outstanding

work and passion for excellence we bring to our

community. We are off to a great start and I look

forward to partnering with you as we surge forward

into the future.

Regards,

Rich Boehler, MD, MBA, FACPE

If you can't feed a hundred people then feed just one

Published by the Planning and Marketing Department for the Medical Staff of St. Joseph Healthcare. Please

send your comments or suggestions to Dr. William Stephan at wstephan@sjhnh.org. Forward news

information and articles to Tiffany Sullivan at tsullivan@sjhnh.org.

Rich Boehler, MD,

President/CEO of By: Carrie Hogan, MSN, RN, CMSRN—Education & Professional Development

Promoting Early Mobilization in the Hospitalized Patient

Education regarding the importance of early mobilization is but one step in the journey to mobilizing patients; encouraging and supporting

these efforts is one step farther. By using the Activity per Protocol activity order appropriately, and utilizing the new Functional Assessment

Mobility Algorithm, it becomes much easier for staff RNs and LNAs to safely mobilize their patients. Though the Activity per Protocol order

has been in place for quite some time, effective education and implementation may have been overlooked. Updates and support for the

protocol have been rejuvenated, which will combine efforts with the Mobility Algorithm process that has been developed to aide the bedside

nurse to initiate discussions for a physical therapy consult earlier in the patient’s admission for appropriate consults. Together, these tools

should provide the base for helping team members to mobilize early, educate patients and involve interdisciplinary members to become

involved in order to prevent bedrest associated complications.

Potential Benefits to Early Mobilization

Preventing complications associated with immobility and prolonged bedrest, in itself, is a benefit to mobilize hospitalized patients as quickly

and as often as the patient can tolerate. It is apparent that deconditioning exists when patients are immobile for prolonged periods of time,

however, it may not be as apparent that their discharge disposition is also greatly affected. The ultimate goal of most patients admitted to the

hospital is to return home as quickly as possible, wherever “home” may be; home independently, with family, with services, assisted living,

etc. As healthcare providers, our primary goal should be to support, encourage and thrive to meet this goal set forth by the patient and attempt

to return them home to baseline in a timely manner to prevent further complications. In order to do so, it becomes quite important for the

healthcare team to do everything in their power to help the patient accomplish this goal; especially tasks such as ambulating or helping the

patient to sit up in the chair for meals. Preventing deconditioning is monumental in increasing the number of patients that return to their

baseline living situation and activity status, as well as decreasing length of stay. So, C., & Pierluissi, E. (2012). Attitudes and expectations

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Early Mobilization in the Hospitalized Patient—Continued

Medical Staff Newsletter Summer 2015

Interventions to re-engineer care for Simple Pneumonia

1. Patients will be included in this payment bundle based on a discharge DRG of 177-179 or 193-195. They will be identified by concurrent

coding on admission or the next business day and we will be sure that more complex cases are not coded in the Simple Pneumonia group. An

example might be Pneumonia with Sepsis should be coded as Sepsis. Even with concurrent coding, we will review each Medicare Discharge

in these DRG's before dropping the bill. Case Management and Data collection (Patty, Keli Barnett & Anjie Adie) will be notified of

concurrent coding for pneumonia. Diane Hanson and Gene Robinson are primarily responsible for this effort. ……………………………

2. Risk stratification for readmission will be done on admission or the next business day by Case Management. The beneficiary notice will be

delivered at the same time by Case Management. Those at high risk of readmission will have a template care plan developed and an APRN

home visit at 48 hours if going home. Patty, Doreen and Becky are primarily responsible. ……………………………………………………

3. Improve the efficacy of inpatient care to both reduce the need for post acute care and to reduce the direct variable cost of care.

Implementation of the Early Mobility Protocol is an example of the former and early transition from IV to PO antibiotics would be an

example of the latter. Hospitalists will use the new Pneumonia iForm. We will develop a delirium prevention program to add stimulation, oral

hydration and medication review by pharmacy to the early mobility program. Sheriff Sahadulla, Cindy Arcieri, Carrie Hogan, Marylou

Kosmatka and Liz Whalen are primarily responsible for this effort. …………………………………………………………………………

4. Increase the proportion of discharges going home or home with services vs. SNF or acute rehab. Doreen Bonney, Patty Mock and

Sheriff Sahadulla will be primarily responsible for this effort. ………………………………………………………………………………..

5. Improve efficiency of post acute care, both SNF and Home Health Services, so as to reduce LOS in SNF or HH. SNFist program and

Physiatry consultations in SNF are central to this process. Greg Zuercher and Sheriff Sahadulla are primarily responsible for this effort.

6. Reduce re-admissions and post-discharge ED visits through aggressive care coordination at all transitions of care, use of direct SNF

admissions, use of Observation admissions and APRN visits early after discharge home from any setting during the 30 days post hospital

discharge. Doreen Bonney, Patty Mock, Rebecca Williams, Jim Martin and Karen Beinhaur are primarily responsible for this effort.

7. Palliative care referral for patients appropriate for POLST, palliative care or hospice services. Kristin Fox and Cindy Arcieri primarily

responsible for this effort.

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ICD-10 What is it?

The International Classification of Diseases, 10th Revision. ICD-10 is a

diagnostic coding system implemented by the World Health Organization

(WHO) in 1993 to replace ICD-9, which was developed by WHO in the

1970’s.

ICD-10 for the United Stated consists of:

ICD-10-CM = Clinical Modification (Diagnosis Codes)

ICD-10-PCS + Procedural Coding System (Hospital inpatients only)

ICD-10 Is Almost Here, Are You Ready? Implementation Date: 10/1/2015

ICD-9 Diagnosis Codes

3-5 Numeric Characters

13,000 Codes

17 Chapters

Injuries are Classified by Type (open wound)

ICD-10 CM Codes

3-7 Alphanumeric Characters

70,000 Codes

21 Chapters

Injuries are Classified by Site (head, arm, leg etc.)

Laterality Specific Codes

Each Chapter’s Codes begin with a Specified Alpha Digit. Ex: Respiratory system codes begin with J

Things You Should Know:

Laterality needs to be specified anytime it is applicable.

Adjectives such as acute, chronic, mild, moderate, persistent will help pick

correct I-10 code.

Injuries need to have specification as to whether each visit is initial,

subsequent, or a sequela.

Activities to Better Prepare Yourself for ICD-10:

Assure that your billing, reporting, and medical record software

applications are ready to accept, process and send ICD-10 codes to your

payers. and if you use one, your clearinghouse for claims.

Contact your payers to make sure they are ready to receive the ICD-10

codes and test your claims to insure that they are being received correctly.

Begin some dual-coding (both ICD-9 and ICD-10) to become familiar with

the documentation needed with ICD-10 for your common diagnoses. This

will allow you to see how your documentation affects your code choices.

Note: The PCS portion of ICD-10 was developed

specifically for use in the United States.

Have any Questions?

Diane Hanson, Director, Health Information Management, ext. 63801

Janice Carrier, Director, Billing, ext. 63261

Lisa Harrington, Senior Project Manager, Information Technology Services, ext. 63543

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Call for Presenters

If you are interested in presenting a topic of choice for a

Dinner with the Doctor event please contact Courtney

Barrett in Community Health Education at 595.3168

Medical Staff Newsletter Summer 2015

Go-Live Timelines

Over the past few months, many employees across the

System have assisted with CareLink pre-work and site

visits. Thank you for all of your efforts. Your hard

work and dedication to this project is essential to the

substantial progress being made in the CareLink con-

tracting phase. We hope to have a successful contract

with Good Help Connections in place by early Sum-

mer. There are many details still to be worked out, but

we will follow the tentative timeline for CareLink

deployment. Because we are still in the contract and

pricing negotiation phase, all rollout timelines are

subject to change. …………………………………….

………………………………….

Time line listed under Covenant CareLink Update:

www.stjosephhospital.com/Medical-Staff

The timeline shows CareLink rolling out across our

System in phases over the course of 2016 and 2017.

Key software sunsetting dates played a major role in

the sequencing decision.

Thank you for your patience as we work toward com-

pleting the contracting phase of this System-wide pro-

ject. If you have any questions about CareLink, please

direct them to Covenant’s Chief Information Officer,

Karen Bowling at (207) 991.0923 or

Karen_Bowling@covenanthealth.net.

PROVIDER NEWS St. Joseph Healthcare welcomes new providers:

S t. Joseph Healthcare welcomes board-certified Internal Medicine Provider Xiaoxi Ouyang, MD, to the medical

staff. She received her medical degree from McGill University School of Medicine, Montreal, Canada. Dr. Ouyang completed her internal medicine residency at Greenwich Hospital/Yale University School of Medicine in Greenwich, CT. Her clinical interests include women’s health, hepatitis B/C, gastrointestinal diseases, weight management and preventive medicine. Dr. Ouyang is fluent in English, French and Mandarin. Dr. Ouyang

has joined St. Joseph Hospital Internal Medicine at 17 Riverside Street in Nashua. To learn more or to make an appointment with Dr. Ouyang, please visit www.stjosephhospital.com or call (603) 595.3614.

T hrough a partnership with Lahey Hospital & Medical Center, in Burlington, MA, Elizabeth Munro, MD,

provides gynecologic oncology care at St. Joseph Hospital. Dr. Munro received her medical degree from Columbia University, New York, NY. She completed her residency in obstetrics and gynecology at Stanford University Medical Center in Stanford, CA, and her fellowship in gynecologic oncology at Massachusetts General Hospital. Additionally, Dr. Munro spent five years as an assistant professor in the division of gynecologic oncology at the Oregon Health and Science University in Portland, OR. To make an appointment with Dr. Munro, please call (781) 744.8560...… …………………………………..……………

K hawaja Rahman, MD, has joined St. Joseph Hospital Neurology Associates in Nashua. Dr. Rahman received his

medical degree from Sindh Medical College, University of Karachi, Karachi, Pakistan. He completed his residencies at South Chicago Community Hospital, Chicago, IL, and Howard University Hospital, Washington, DC, and his fellowship in Neurophysiology at Howard University Hospital, Washington, DC. To make an appointment with Dr. Rahman, please call (603) 881.7100.