What We Tried

An opportunity arose to work with a doctoral student from Louisiana State University on a project specific for Greenbriar’s site. The team gathered data to examine the current patterns of re-hospitalization occurring in the facility. A sample from a one-year period was collected. It focused on admission day of the week and shift, transfer day of the week and shift, risk level of the resident, referring location, primary and secondary diagnosis, primary reason for re-hospitalization, level of care and hall location.

Once the initial data analysis was completed, and two primary locations (halls) were identified as the locations for the highest number of re-admissions, the team conducted further analysis . Acuity level by hall had not historically been a standard method to plan staffing in this setting. Using a multi-day sample of resident mix per hallway, the team compared the minutes of care as outlined by CMS per its resource utilization group (RUG) for each set of Greenbriar residents. This allowed the center to compare the routine staffing for each hall with the anticipated staffing needs.

Through understanding the patterns of re-hospitalizations in Greenbriar’s facility, the center was subsequently able to align its interventions. Some interventions included:

-Hiring a registered nurse designated for the early evening hours when the primary admissions related to re-hospitalizations occurred.

-Reassigning workload on halls identified to need higher RN coverage.

-Educating certified nursing assistants on ‘stop and watch,’ emphasizing the importance of minor changes in condition.

-Conducting joint review of data findings with all key team members with plan for a Quality Assurance and Performance Improvement (QAPI) team initiative.

There are a number of additional strategies discussed with the initial team. Based on its findings and interventions, a more formal team will be developed to assure follow-up, goal setting and the spearheading of a focused QAPI initiative.