Becker's Clinical Quality & Infection Control

19 T hirty-day readmission rates for hip and knee replacements at Indiana University Health Saxony Hospital are at 0.74 per- cent, more than seven times lower than the na- tional average. Length of stay is also on the ex- treme low end. So how does the 42-bed hospital in Fishers do it? The answer stretches back to one surgeon's expe- rience at a hotel. A Ritz-Carlton hotel. R. Michael Meneghini, MD, an orthopedic sur- geon who directs IU Health Saxony Hospital's joint replacement program, was planning to propose to his now-wife at a Ritz-Carlton, but a snowstorm hampered his plans. Still, staff at the luxury hotel helped his proposal go smoothly de- spite the setback. "They were with us every step of the way," he says. Impressed with the customer service, Dr. Meneghi- ni started thinking about how it could translate to his own industry. He had heard that the Ritz-Carl- ton holds daily meetings with staff to get everyone on the same page for every guest. "If the patient is the customer, why can't we do the same thing in medicine?" he asked himself. Now, the team at IU Health Saxony Hospital does something similar: Every Friday morning, the entire perioperative team gathers at the hospital to discuss the next week's upcoming patients and scheduled surgeries. The meeting includes internists, surgeons, anesthesiologists, nurses, the OR team and even device company representatives and the hospital chaplain. They discuss all aspects of patient care, like what implants will be used and any medical condi- tions the upcoming patients might have. "Everyone is willing to [come in] on their own time, come in early on a Friday," Dr. Meneghini says. "We are very fortunate to have a group of peo- ple who truly go the extra mile to care for patients." While the care-coordinating meetings have posi- tively affected clinical measures like length of stay and readmission rates, patients have also taken notice. Patient satisfaction has been extremely high for several months now, according to Dr. Meneghi- ni. "It's palpable to the patient. It seems like we have our act together," he says. "People aren't asking them the same questions over and over and aren't surprised by an unusual case" since everything has been worked out prior to the surgery. It's possible elsewhere IU Health Saxony Hospital's perioperative team has held these meetings since the hospital opened its doors about two and a half years ago. "That's one of the things that facilitated the program the most…there were no preexisting culture or pat- terns to change," says Dr. Meneghini. However, for established hospitals considering a similar hospitality-inspired program, a strong surgeon leader is critical. "If you don't have a sur- geon leader to drive [the effort], it's not going to go anywhere," he says. Support from the executive level is also paramount. To gain executive-level buy in, Dr. Meneghini rec- ommends highlighting the cost savings this pre- surgery approach can generate. The meetings can lead to reduced medical errors and shorter hospital stays, both of which impact a hospital's bottom line. He recommends educating the executives on the fi- nancial benefits when first presenting the program. The fact that all of the positive impacts on care coordination, healthcare costs, outcomes and pa- tient satisfaction at IU Health Saxony Hospital stem from one excellent experience at a hotel goes to show that healthcare leaders can learn lessons anywhere. "Maybe the Ritz-Carlton deserves part of the credit for their influence on our program," Dr. Meneghini quips. n Why One Hospital Thanks the Ritz-Carlton For Low Readmission Rates By Heather Punke Study: 40% of Critical Information Omitted During Morning Handovers By Akanksha Jayanthi T horough communication appears to be lacking during morning handovers, according to a study in JAMA Internal Medicine. Researchers observed third-year medi- cal student and first- and second-year residents during their morning handovers following an overnight shift. They found the on-call trainees omitted 40.4 percent of "clinically important issues" during these morning handovers. Additionally, the trainees did not document any of these issues in the patient's medical record 85.8 percent of the time. Researchers suggest training programs should utilize educational activities and workflow changes to improve handover communication regarding on-call issues, according to the study. n SIGN UP TODAY! Infection Control & Clinical Quality Becker's Infection Control & Clinical Quality E-Weekly www.beckersinfectioncontrol.com or call (800) 417-2035

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