Care Without Delay

Abstracts from the Kaiser Permanente2018 National Quality Conference


Serge Teplitsky, RN; Vivian Reyes, MD; Jennifer Misajet, RN;
Catherine Winarsky, MPH, BSc (Pharm)

From Colorado, Georgia, Hawaii, Mid-Atlantic States, Northern California, Northwest, Southern California, Washington, Program Offices

Background: Care Without Delay (CWD) is a model of care developed by Kaiser Permanente (KP) Southern California (KPSC) in Baldwin Park, which quickly produced remarkable outcomes. By aligning delivery system processes, CWD improves care timeliness, removes system barriers to care, provides a great care experience, and produces cost savings in a true Triple Aim fashion. Because of Baldwin Park’s outcomes, it was spread throughout KPSC and subsequently through KP Northern California (KPNC) with similar results. Now, it is being implemented in all Regions as KP’s operating model.
Methods: Problem: Many hospital admissions are preventable and frequently patients are not cared for at the right level of care. Untimely care and care delays can lead to longer length of stay, hospital-acquired infections, increased costs, and reduced patient satisfaction. KP strives to improve quality of care in a highly reliable fashion. Intervention: A care team addresses all patient (medical and nonmedical) needs in a timely manner. The focus is on doing today’s work today, long-term care planning, real-time peer review, escalations, communication and collaboration, and 24/7 staffing with strong leadership and oversight. Comparison: Baseline data (patient day rate [PDR], average length of stay, readmission rate, etc) from the previous year. Outcome Measure: Reduced PDR and improved quality, safety, and experience for patients.
Results: Benefits realized from CWD implementation have included a decline in PDR from > 300 to ~ 220 in KPNC and KPSC, decreased hospital mortality and reduced variation in PDR across KPNC facilities, and a decline in avoidable hospital days and care costs. The foundation for these results lie in the close patient care coordinator (PCC) and hospitalist partnership focused on the patient, including daily multidisciplinary rounding with the physician, the PCC, a bedside nurse, and the patient or patient’s family, allowing immediate removal of barriers and escalation when necessary. Outcomes are a result of timely service availability at all hours, including weekends and after-hours (7-day hospitals), a focus on extended length of stay patients and reduced postacute placement barriers. In addition, CWD has received positive feedback from staff, physicians, and patients.
Discussion: CWD is an operating model that improves the quality and affordability of care KP members receive. It is a hospital-based model, but it can be adapted for non-KP facilities/Regions and services outside the inpatient setting. CWD provides a strong foundation on which to build other initiatives. Innovations for success include strong long view of care planning and application in other areas (eg, ambulatory care, skilled nursing facilities, behavioral health). Success factors for further spread include leveraging the Xcelerating Learning and Spread model as a common language for communication and to better understanding Regional status and needs.

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