Quality Improvement and Clinical Documentation Integrity

Projects:

Does knowledge of discharge time increases timeliness of discharge order placement ?

This project was based on the concept that dynamic feedback with peer benchmarking has the potential to positively impact physician behavior with regard to discharge order placement times. Early discharge order placement is critical for capacity optimization at Froedtert Hospital, Milwaukee.

Impact

  • The proportion of discharge orders placed before 11:00 am increased from 22% in the4-week period leading up to our project to 35% over the 6 weeks we sent out daily email (p value, chi square of proportions = 0.018).
  • Poster presentation, National Meeting of Society of General Internal Medicine,Denver, Colorado
  • Abstract was published in National peer reviewed journal. “Does knowledge of time of discharge increase timeliness of discharge order placement?” Journal of General Internal Medicine (2018) 33(Suppl 2): 83. https://rdcu.be/dcJTS

Discharge when medically ready

The timing and pace of patient discharges are not level-loaded throughout the day at many institutions including our own. To address this issue, I represented the section of hospital medicine as a co-lead todevelop the“Discharge when medically ready” model at FMLH. The model is derived from the findings of a comprehensive, multidisciplinary needs assessment grounded in process improvement principles to help identify barriers and solutions to facilitate early discharges. This project was piloted in November 2018 and has been implemented on all medicine floors.

Impact

  • There was significant improvement in discharge orders by 10:00 am from pre-implementation 18% in October 2018 to 40% by February 2019
  • Poster presentation: Discharge when medically ready, part 1 National meeting of Society of Hospital Medicine (03/2019)
  • Poster presentation: Discharge when medically ready, part 2 National meeting of Society of Hospital Medicine (04/2020)
  • Abstract published at Hospital Medicine 2019, March 24-27, National Harbor, Md. Abstract 356. https://www.shmabstracts.com/abstract/discharge-when-medically-ready/
  • Publications: Sharma-Segon Y, Ahluwalia S, Sharma N, Segon A et al. “Discharge when medically ready.” Wisconsin Medical Journal. July 2022 https://wmjonline.org/121no2/segon/

Other Projects:

  • Topic
    • Academic hospitalists and dynamic feedback-A qualitative study
  • Role
    • Member of project team
  • Dates
    • 08/2015 - 04/2016
  • PI
    • Dr. Ankur Segon
  • Location
    • Medical College of Wisconsin, Milwaukee, WI
  • Topic
    • Dynamic feedback in the inpatient setting to improve HCAHPS scores-A quality improvement study.
  • Role
    • Member of project team
  • Dates
    • 09/2015 - 12/2015
  • PI
    • Dr. Ankur Segon
  • Location
    • Medical College of Wisconsin, Milwaukee, WI
  • Topic
    • Dynamic feedback and discharge time on GIM floors-A Quality Improvement project
  • Role
    • Principal investigator
  • Dates
    • 10/2016 - 12/2016
  • PI
    • Dr. Yogita Sharma Segon
  • Location
    • Froedtert Hospital
  • Topic
    • Predictors of early readmissions-Retrospective study
  • Role
    • Member of project team
  • Dates
    • 12/2016 - 06/2018
  • PI
    • Dr. Hiro Kato
  • Location
    • Froedtert Hospital
  • Topic
    • Discharge when medically ready
  • Role
    • Member of project team
  • Dates
    • 03/2018 - 12/2019
  • PI
    • Verna Seitz
  • Location
    • Froedtert Hospital
  • Topic
    • Improvement in the Quality & Standardization of an Internal Medicine Residency VA handoff tool
  • Role
    • Faculty facilitator
  • Dates
    • 08/2022 - Present
  • Location
    • Audie L.Murphy VA Medical Center, San Antonio

Poster Presentations

National

  • 04/2018
    • Segon Y, Segon A, Lamb G. Does knowledge of time of dischargeincrease timeliness of discharge order placement?
    • Poster presentation, National Meeting of Society ofGeneral Internal Medicine Denver, Colorado
  • 03/2019
    • Segon Y, Ahluwalia S, Bhandari S, Christopher E, Seitz V, Segon A. Dischargewhen medically ready, part 1
    • Poster presentation, National meeting of Society of Hospital Medicine
  • 04/2020
    • Segon Y, Gaspich J, Christopher E, Seitz V, Buth C, Sharma N, Segon A. Discharge when medically ready, part 2
    • Poster presentation, National meeting of Society of Hospital Medicine
  • 04/2020
    • Segon A, Segon Y, et al. Improving quality by providing feedback to frontline providers
    • Poster presentation, National meeting of Society of Hospital Medicine

Regional

  • 09/2017
    • Segon Y, Segon A, Lamb G. Does knowledge of time of dischargeincrease timeliness of discharge order placement?
    • Poster presentation,Midwest Society ofGeneralInternal Medicine Chicago, IL

Local

  • 06/2017
    • Segon Y, Segon A, Lamb G. Does knowledge of time of discharge increase timeliness of discharge order placement?
    • Poster presentation, Faculty Scholars in Quality and Safety program. Medical College of Wisconsin
  • 09/2017
    • Segon Y, Segon A, Lamb G. Does knowledge of time of Dischargeincrease timeliness of discharge order placement?
    • Poster presentation, MCW Research day Medical College of Wisconsin
  • 03/2019
    • Segon Y, Ahluwalia S, Bhandari S, Christopher E, Seitz V, Segon A.Dischargewhen medically ready
    • Poster presentation, Department of Medicine Research Day. Medical College of Wisconsin

Publications

1

Segon A, Ahmad S, Segon Y, Kumar V, Friedman H, Ali M. “The effect of rapid response teams on outcomes in a community-based teaching hospital.” Journal of Graduate Medical Education 2014 Mar;6(1):61-4 https://pubmed.ncbi.nlm.nih.gov/24701312/

2

Segon A, Kato H, Segon Y, Kumar V. “A qualitative exploration to understand hospitalist’ attitude toward the patient experience scoring system.” Journal of Patient Experience. March 2020.

https://doi.org/10.1177/2374373520942418
3

Becker B,Nagavally S, Wagner N, Walker R, Segon Y, Segon A. "Creating a culture of quality-our experience with providing feedback to frontline hospitalists." BMJ open quality. January 2021

https://bmjopenquality.bmj.com/content/10/1/e001141.abstract
4

Yang E, Zhou Z, Walker R, Segon Y, Segon A. “The impact of Hospitalist Switch Day on Length of Stay.” Quality Management in Healthcare. July 2021

https://pubmed.ncbi.nlm.nih.gov/34326291/
5

Sharma-SegonY, Ahluwalia S,Sharma N, Segon A et al. “Discharge when medically ready.” Wisconsin Medical Journal. July 2022

https://wmjonline.org/121no2/segon/

ABSTRACTS

1

Segon Y, Segon A, Lamb G. “Does knowledge of time of discharge increase timeliness of discharge order placement?” Journal of General Internal Medicine (2018) 33(Suppl 2): 83. https://rdcu.be/dcJTS,

2

Segon Y, Emanuel, C; Ahluwalia, S; Bhandari, S; Seitz, V; Segon, A. “Discharge when medically ready.” Abstract published at Hospital Medicine 2019, March 24-27, National Harbor, Md. Abstract 356.

https://www.shmabstracts.com/abstract/discharge-when-medically-ready/