Monroe County Hospital Achieving Outcomes

April 2017
National Rural Health Resource Center (The Center)

Monroe County Hospital (MCH), located in Monroeville, Alabama, is a prospective payment system (PPS) hospital with 35 staffed beds. They provide medical, surgical and emergency services; an intensive care unit; obstetrics; oncology; computerized tomography/MRI/digital mammography; cardiopulmonary services, including cardiac testing; respiratory therapy; sleep studies; and physical, occupational and speech therapy. Their motto is “Caring for our community close to home.” 

Carla Brock Wilber, Senior Consultant, with Stroudwater Associates, worked with MCH in 2016, through the Small Rural Hospital Transition (SRHT) project, on a Quality of Care and Transition of Care Project.  RHI staff spoke with Jeffrey Brannon, CEOBarbara Harned, CNO and Ann Marie White, case management director, concerning their progress on this project.

Q: What are some of your hospital's successes regarding the implementation of Carla’s recommendations?
 “We’ve implemented everything Carla recommended!”

A number of strategies addressing the education of the patient and family have been implemented. Case management and transition of care education is going well from the start of admission to discharge. Since caregivers at home are often critical to the well-being of the patient, education for them has been enhanced and health care literacy is carefully considered. Discharge forms have been re-engineered. Focusing on patient education has been helpful in reducing readmission rates since better education in the hospital will help keep the patient at home. The respiratory director has just implemented an education form for her therapists to use when teaching or giving treatments.  “We are hoping that this will also help keep patients from returning to the hospital.”

Local pharmacists have been invited to be more involved to create a smoother transition of care. Medication lists are sent to the pharmacists so they know what new medications the patient has been prescribed and what medications have been discontinued. In addition, pharmacy and case management have been very involved with and are helping to make the patient portal initiative a success.

MCH created a care transition team that includes former patients. They can advise the hospital concerning their experiences. The hospital received feedback that they are educating patients well. To continue to work towards improvement, MCH will invite other patients that may have been less satisfied to future meetings to discover the gaps and barriers. 

Implementing bedside reporting was challenging, as is often the case for many hospitals. The staff is now onboard and they continue to work with physicians to increase their buy-in.

To make it as successful as possible, staff were educated about bedside report prior to the roll out and they are encouraged to ask questions if they are not sure if something should be shared. Leadership focused on explaining the “why” behind it and held staff consistently accountable until they began to see the value in the process. “Our HCAHPS scores have improved.  They were good before, but now they are excellent.  The processes we have put in place such as bedside reporting at the change of shift have made an improvement in patient care.  Sometimes the staff is still unsure how much they should say in front of the patient, but they are definitely getting more comfortable.”

An area the hospital will continue to address is physician compliance, specifically with timely discharge summaries.  To assist with accountability, compliance numbers are now reported at the Medical Record Review Committee.

Q: What are some of the outcomes from this project and ways it impacted your hospital and community?
 MCH has documented several measurable outcomes and include:

  • Readmissions have decreased from 14.3% to 12.6%
  • HCAHPS discharge planning scores have increased from 86% to 91%
  • HCAHPS care transition scores have increased from 49% to 52% which is at the state and national levels
  • Hospital has not received any denials

The project has also impacted the hospital in non-measurable ways. The community engagement has improved through outside pharmacies being more involved in the transition to home. In addition, the community is seeing their positive outcomes and are more likely continue to utilize services. Within the hospital, there is an increased engagement in a culture of safety.

Q: How do you believe this project has helped you move forward in the newly emerging system of health care delivery and payment?
 The project enhanced what they were already doing and is assisting MCH to be a strong and viable hospital. It was clear that value-based purchasing was coming and the preparation allowed them to avoid a decline in reimbursement. ”(The project) forced us to do things we knew we wanted to do.”