Guadalupe County Hospital Improves Patient Discharge Experience

Mary Guyot, Principal, and Carla B. Wilber, Senior Consultant with Stroudwater Associates, worked with GCH in 2015, through the Small Rural Hospital Transition (SRHT) project, on a Quality Improvement and Transition of Care project. RHI staff spoke with Christina Campos, Chief Executive Officer concerning their progress with this project.

Q: What are some of your hospital's successes regarding implementation of Carla and Mary's recommendations? 

A: The discharge process has improved substantially. New discharge packets were created for patients and include information such as an introductory letter, condition-specific information, information about the patient stay, goals and how to monitor care at home. The packets are condition-specific color-coded to make it easier for staff to access. A new pharmacy tech was hired so that the pharmacist would have more time to be hands on at the patient bedside to assist with medication education.

The hospital has raised staff awareness concerning the impact and importance of scores. Christina spends time with the nurses discussing not only the scores but the impact of re-admissions. This has led to more nurse buy-in. Scores are posted and are discussed with physicians individually as well. GCH added five new providers who are very engaged with patients and understand how important this is.

Utilization review policies and forms have been redone. Physician contracts were created to financially recognize them and to help attract other providers to the hospital. As a result of this project, GCH has also discovered some of the issues behind their challenges and are well underway to fix them. In particular, they discovered documentation opportunities around influenza immunizations and VTE.

When GCH was unable to implement a consultant recommendation, they creatively found other ways to reap the benefits. When they were unable to hire a coder or biller, they had their own staff certified. This was significant and also created a way for them to network with peers from other hospitals. In addition, staff is pitching in to help meet patient needs.

GCH is committed to using the project recommendations as a roadmap for future improvement.

Q: What are the expected next steps towards adopting your consultants' recommendations? 

A: The next areas to be addressed include:

• Continue addressing documentation issues
• Continue to create discharge packets for different diagnosis
•  Tweak follow-up call questions and keep logs
• Use Community Health Needs Assessment (CHNA) info they are currently completing to continue to look at next steps
• Pull applicable measures into scorecard

Q: What are some of the outcomes from this project, both measurable outcomes and those that aren’t measurable but demonstrate the impact of this project on your hospital and community? 

A: GCH exceeded their goal for patient satisfaction discharge composite questions. Their pre-project percentile was 69% and they are presently at 89.5%. Readmission rates have remained fairly steady and they continue to focus on this outcome as well as influenza immunization rate.

While not measurable, this project impacted the culture of GCH by:

•  Providing a roadmap for future initiatives
•  Helping community and staff to see that hospital is proactive and not complacent
• Reinforcing need for continued growth and constant self-reflection
• Helping seasoned doctors have more buy-in to quality measures
• Continuing to improve communication

Q: How do you believe this project has helped you move forward in the newly emerging system of health care delivery and payment? 

A: Creating better measures will impact the hospital’s success. If the time comes when it’s necessary to be part of an ACO, etc. they will be ready for high engagement, high HCAHPS scores and high-quality scores. In the long run, GCH will be a more attractive partner if there is a need to align with others in a new way.