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The Appropriate Use of Accommodations Project – Level of CareInstituted two Best Practice Alerts and recruited faculty champions throughout hospital to drive value at Stanford HealthCare
Assisted in developing data collection tools to explore relative efficiency and quality between health groups. Developed interview guides and/or questionnaires using clinical scenarios to explore care delivery models and practice patterns for Interventional Cardiology, General Cardiology and Nephrology.Site Visit Lead: University of Alabama Site Visit
Hospital Mentor for SHCG: Understand implications of miscategorization “observation status” vs. “inpatient.” The project quantified the rate of patient miscategorization, modeled the substantial financial impact of misclassification (for patients and SHC), and developed recommendations to minimize future errors.
Hospital Mentor for SHCG: Lab test overutilization is a widespread challenge at virtually all medical centers, leading to substantial costs and in some cases, placing patients at risk from unnecessary follow-up tests and procedures. SHCG examined the most commonly-ordered lab tests by cost and volume to evaluate which tests are inappropriately ordered. The team provided reasons for lab test overutilization and prepared evidence-based recommendations to address this problem.
Identified barriers to discharge for clinical high risk patients by recording reasons for delayed discharges through:a.Data collection at clinical high risk patient meetingsb.Interviews of team care members (RNs, case managers, MDs, etc.)Examined the primary barriers to discharge and determine how/when they arise.a.Stratified by medical unit and patient’s primary medical condition to determine whether barriers may be unique to these factors.Assessed the financial burden as a result of delayed discharges.Formed recommendations to address these primary barriers to discharge that may be implemented in the immediate future, as well as, in the short term and long term.Work Presented at ACP Northern California in November 2014
Hospital Mentor for SHCG: The ED Admissions project team has studied emergency room admissions processes and the determinants of patients being admitted to telemetry and non-telemetry beds as well as patients being admitted under inpatient or observation status. By analyzing ED admissions data, conducting a wide range of interviews with key staff and stakeholders, and closely observing ED operations, the team has improved understanding of how admitted patients are currently being placed and developed recommendations for improvement.
Practicum preceptors have the opportunity to work with 2 different groups of students teaching history taking skills / physical examination skills.
The University HealthSystem Consortium (UHC) is a data driven collaboration among nonprofit academic medical centers across the nation. The purpose of this alliance is to drive and support better patient care by sharing data to identify areas of improvement in patient outcomes, quality of care and costs. The SHCG group project aims to understand Stanford's cost per case.
A Co-Director of the Patient Partners Program, an innovative longitudinal patient-student service curriculum within SHIELD (Stanford Healthcare Innovations and Experiential Learning Directive)
Trainees are put into clinical multidisciplinary teams with little knowledge about their non-MD colleagues. Trainees often are not aware of the specialized expertise these healthcare professional team members possess (e.g. social work, case management, nursing, respiratory therapy, and occupational therapy) and are compelled to try to understand the often vague and fraught environment of interdisciplinary hierarchies and team dynamics. This lack of knowledge and training results in confusion and missteps that can lead to patient care errors, poor communication, hostile working conditions, and decreased job satisfaction. Our project will survey interns and allied health professionals to identify knowledge gaps and barriers to inter-professional practice. The information will be used to create teaching videos addressing these gaps, while also stimulating discussion about hierarchies in healthcare, as well as goals of, and potential barriers to, collaboration in practice. Videos will be targeted towards medical students and advanced practice providers, preparing them for inter-professional collaboration when entering practice, clerkships and residencies.
Optimizing length of stay (LOS) was identified as one of the overall Stanford Health Care quality initiatives across all departments. This project involved exploring who the LLOS patients were, the barriers to discharge, the workflow, and recommendations for addressing this important hospital issue
Jingkun Yang MD , Jessica Ferguson MD , Surbhi Singhal MD , Christopher Sharp MD , Benjamin Leung , Dale Beatty DNP RN , David Svec MD MBA , Lisa Shieh MD PhD  Abstract for the Resident/Fellow Quality Improvement/Patient Safety Symposium (QIPSS)
QI Symposium - Ginger Yang, Lisa Shieh, Bo Wang
Arifeen S Rahman, AB1; Pamela Meza, BS1; Siyu Shi, BS1; Justin Jia, BS1; David Svec, MD, MBA2; Lisa Shieh, MD, PhD2Stanford University School of Medicine1 and Department of Medicine2, Stanford, CA
Improving O:E Mortality at SHC Faculty Leads: Jason Hom / Lisa Shieh / David Svec
Patient Experience: Quiet at Night/Inpatient SleepFaculty Lead: Lisa Shieh / David Svec / Ed Sheen
SHC Cost: Limited Echo Faculty Lead: Lisa Shieh / David Svec
Integration of Stanford HealthCare - ValleyCare - Radiology into the Enterprise Contact Center algorithm.
Integration of Stanford HealthCare - ValleyCare - PT/OT into the Enterprise Contact Center algorithm.
Supervised PA student from Touro University to understand Quiet at Night Hospital Compare metric at Stanford Health Care - ValleyCare
Malnutrition specificity is consistently one of the top CDI queries at SHC-PA. This can result in missed opportunities for earlynutritional interventions, impacts on quality and finance metrics.
CORT participant to align COVID response between SHC, SHC-VC, LPCH, and UHA.
Updated portal demonstrating hospital call agreements
Establish and monitor SHC-VC Medical Directorship agreements/Physician Call agreements
Strategize the use of solar energy for SHC, propose plans for organizational changes and prepare a pitch for the importance of sustainability to leadership.Build on existing foundation of SHCG project that identified sustainable practices as a need at SHCCollaborate with Stanford University (Stanford Health and Climate Taskforce) and Stanford Healthcare (Director of Sustainability) for solar energy proposal Investigate Stanford University strategic reasons for the stock farm solar arrayEvaluate feasibility, use case, methods, benefits, return on investment, etc. of pursuing solar energy
The group will compare different short-term and long-term options, evaluate clinical efficacy and cost-effectiveness, and propose a strategic plan and potential business partnerships. Evaluate need for telemedicine consults and telemedicine physical exams at SHC, short-term (in the COVID-19 condition) and long-termAssess perception by clinicians and hospital patients of potential adoption of new technologiesResearch recent health policy changes and reimbursement changes that impact billing for inpatient care with telemedicineScope out options for telemedicine equipment and technology providers, for both short-term rental and long-term subscriptions
Reducing inappropriate magnesium ordering within Stanford Hospital (saving Stanford upwards of $1M annually)
Sustainable Actions for High Value Energy and Efficiency Scoping (Exlpore areas where solar energy can be leveraged across Stanford Medicine/Hospital)
Redesign Epic interface and creation of single referral queue for Stanford Medicine
To develop a proof of concept and scalable framework to implement a simplified Primary Care referral system:Streamline primary care new patient visit typesIntegrate processes to create a common work queue driven by patient preferencesIncrease scheduling visibility across the system by leveraging team scheduling capabilitiesEnable efficient self scheduling and positive user experience
Expaneded Cost Savings Reinvestment Program to SHC-VC
Stanford Health Care – ValleyCare, a 160+ bed hospital located in Pleasanton, recently completed its 5 year strategic plan. One of the main components listed in the strategic plan is further developing the education and research mission. Stanford Health Care – ValleyCare has succeeded in starting numerous PA and Resident rotations. The strategic plan identified the creation of a GME Family Medicine Program as an opportunity for Stanford Health Care – ValleyCare. This project would work directly with the SHC-VC CMO, SHC-VC Academic Physician in Chief and the SHC-VC Medical Director for Education to define the steps and resources needed to launch a new training program.
1 in 5 Medicare beneficiaries is readmitted within 30 days of hospital discharge, incurring a cost of over $26 billion each year (Leppin et al. 2014). Policymakers have identified preventable hospital readmissions as a leading US healthcare problem, reducing reimbursement for hospitals with excess 30-day readmissions (Fontanarosa et al. 2013). In addition to cost savings, reducing readmissions is crucial because rehospitalizations jeopardize the health of elderly patients who are particularly susceptible to hospital-acquired infections and poor outcomes when hospitalized.There is increasing evidence that proper transitions of care (TOC) can improve readmissions. The development of the transitionalist program in 2017 was successful in reducing pneumonia readmissions from 22.4% to 10%. This project will focus on one DRG on General Medicine. It will look for opportunities to improve the readmission rate for that DRG.
High value care - reducing inappropriate magnesium lab ordering
Sustainability Project - Exploring Reusable Gowns
Hospital Medicine Colocation Floor Project
Of all the different healthcare settings in the United States where patients receive care, perhaps the most familiar to us is the hospital setting. However, this is not the setting where patients actually spend most of their recovery time. These settings, where patients go after the hospital, are called post-acute facilities, and they include long term acute care facilities, subacute facilities, and skilled nursing facilities. While these settings are often less understood, by both lay and healthcare professionals alike, they are an incredibly important component of our healthcare infrastructure. This project explores the crucial and complex relationships between hospitals and post-acute settings. We will go over definitions, clinical and financial implications for patients, financial and operational implications for hospitals, and innovative ways to spur collaboration that promotes continuity, efficiency, and value.Please list expected deliverables:Improved understanding of the differences among hospitals, LTACHs, Subacute facilities, and SNFsAbility to articulate the financial implications to the hospital in transferring patients to these facilitiesEnhanced appreciation for the importance of relationship building and collaboration with community partners to ensure solvency and sustainability
Stanford Health Care has set an operational goal within the Quality, Safety, and Health Equity domain for a 30-day readmission rate of <12% and length of Stay Index of < 0.88. On the Medicine teams, interdisciplinary team (physicians, nursing, therapy services, nutrition, and case management) huddles are critical to arrange care and follow-up to achieve these effectiveness metrics. The interdisciplinary team huddles have changed forms multiple times in the past 5 years. COVID protocols have also influenced the structure of the team huddles with the interdisciplinary team. The SHCG group will assess the current afternoon huddle structure: best practices, opportunities, and successes. The SHCG group will also assess what happens to the information shared and what, and to whom, the information gets escalated if there are delays and / or gaps in care. Please list expected deliverables:Assessment of the afternoon interdisciplinary team care rounds huddleBest practices, opportunities, and successesFlow chart of escalation pathways: current vs. desired state
The United States spends more on health care than any other country, with costs approaching 18% of the gross domestic product (GDP). Prior studies estimated that approximately 30% of health care spending may be considered waste "Linen is the last bastion of pure, true savings hospitals can tap into, simply by reducing unnecessary waste," says Jake McCuistion, Executive Vice President of Patient Flow and Linen Utilization Management (LUM) with HHS. "Linen management can be very time consuming, so hospitals have to invest in order to run this kind of program effectively in-house." SHC spends more on linens compared to other medical centers of similar size. It is important to understand the root cause of linen waste so that we can consider other sustainable projects such as relaundered gowns. SHC has created a 5 year mission to be a leader in healthcare sustainability. Please list expected deliverables:Determine the root cause of linen waste at SHCUnderstand current state of linen use and wasteDiscuss with key stakeholdersSurvey healthcare workers on attitudes towards sustainability Literature review of best practicesRecommendations to reduce linen waste
High Value Care: Leading quality improvement projects / research initiatives