Evergreen Medical Center Remains Committed to Quality Care

September 2018
Organization: 
National Rural Health Resource Center (The Center)

Evergreen Medical Center (EMC) is a 44-bed, for-profit, short-term acute care hospital (STAH) providing acute care, emergency medicine, rehabilitation therapies, imaging, lab, surgical services, home health and primary care to the residents of Evergreen, Alabama and surrounding communities. EMC is committed to delivering quality healthcare in an atmosphere of compassion, sensitivity and respect meeting the needs and expectations of the individual, family, and community.

Carla Brock Wilber, Senior Consultant, with Stroudwater Associates, worked with EMC in 2017, through the Small Rural Hospital Transition (SRHT) project, on a Quality of Care and Transition of Care Project.  Center staff spoke with Melissa Dunn, Chief Operating Office, at six and twelve-month post project about the implementation of the consultant recommendations.

Q: What are some of the recommendations that you’ve implemented and what are your next steps?

A: To impact the patient experience, EMC implemented education for staff and more staff involvement with new admissions. They post satisfaction scores in shared areas. In addition, EMC created a committee to address HCAHPs issues. With the intention of partnering with the community, they invite customers to attend the customer service meetings to provide input. In an effort to constantly improve, they are specifically hoping to include someone who can discuss concerns about their stay.

Accurate, complete and timely clinical documentation is critical to the care of the patient and the reimbursement of the hospital. Care management developed a training for providers and created a guide that identifies words to prompt the provider to document the type of heart failure. The coder and case manager are working together on an education to improve the understanding of providers and nurses about how good documentation of full assessment impacts reimbursement. Tip sheets were also created to assist in the appropriate patient placement for inpatient versus observation.

To improve transition of care and prevent readmissions, EMC implemented discharge follow up calls at 24-48 hours, post-discharge. So far, they have caught concerning issues quickly and have discovered cases when a patient forgot an appointment or what they needed to do for home care. They are hopeful this will also positively impact patient compliance. They plan to create classes to further reinforce the importance of diet, exercise and medication. The hospital team recognizes that they are giving a lot of information to patients. They are considering creating magnets for a hotline number that patients can call post-discharge to get information. They are also exploring partnering with a community member to provide additional patient education prior to the busiest discharge days.

Previously, EMC’s directors separately attended and reported their quality issues in the quality meeting. Once that director reported, they were free to leave the meeting and the next director took their place. To improve quality reporting and create more collaboration among departments, EMC now includes all directors for the entire meeting. Each director reports quarterly about quality issues they are addressing. This leads to discussion across departments in an effort to support each other and provide input. This new process, as well as the public posting of scores has led to more transparency and shared ownership.

Q: What has been the impact of this project so far on EMC?

A: HCAHPS have continued to hold at 89.9% for “patients who reported that YES, they were given information about what to do during their recovery at home.” For “patients who strongly agree they understood their care when they left the hospital,” EMC surpassed their goal of 54%’ile and is currently at 54.89%’ile. While not meeting their readmission rate goal to be below 14%, EMC does report improvement in their two most common readmission diagnoses. Pre-project data for heart failure was 24.4% and is currently at 20.8, tracking below the state average of 21.6%. For COPD, pre-project readmission rate was 20.1% and is currently at 19.3%, again below the state average 19.8%.

Non-measurable impact includes:

  • More transparency and better collaboration across departments regarding quality
  • More awareness of needs in community for increased education
  • More compassionate communication from staff towards patient
  • New realization that community has high expectations and continuous improvement takes focus
  • Realization we need to “beef up our game.”

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

A: “While perhaps not a first adopter, EMC is more prepared and ready for our future environment.”