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Recommended Citation
Jacobson C. High risk for readmission criteria for wound care patients. Quality Improvement podium presentation at Empowering Nursing Excellence: Recognizing the Value and Impact of Nurses, Advocate Health Midwest Region Nursing Research & Professional Development Conference 2023; November 15, 2023; virtual.
Presentation Notes
Quality Improvement podium presentation at Empowering Nursing Excellence: Recognizing the Value and Impact of Nurses, Advocate Health Midwest Region Nursing Research & Professional Development Conference 2023; November 15, 2023; virtual.
Abstract
Background: The most common reported complication of diabetes mellitus is diabetic foot ulcers. Outpatients with diabetic foot wounds are at an increased risk for all cause hospitalization. Moreover, diabetics socioeconomic status has been shown to influence health outcomes associated with disease management.
Local Problem: At a Midwest quaternary medical center, within the outpatient wound clinic and Aurora Limb Preservation Program (ALPP), the 30-day hospital admission percentage for patients with diabetic foot ulcers was elevated in January 2022 (16%) and February 2022 (19%).
Method: A quality improvement project, utilizing A3 methodology, was initiated to proactively address patients’ social determinants of health (SDOH)and decrease hospital admissions for this population to less than 12% of monthly percentage of patients seen in ALPPs. The project included a redesign of outpatient limb preservation diabetic foot ulcer patients workflow with the addition of incorporation of social determinants of health screening questions on patients that scored 65% or higher for readmission in March of 2022. The questions specifically target physical activity, transportation, housing, financial and resources, food insecurity, and social connections. Referrals are provided for diabetic education, home health, financial counseling/advocates, and community-based case managers. Patients are asked screening questions each visit, and issues are addressed immediately in the clinic to assist with individual patient needs.
Results/Conclusions: Hospital admission for these patients decreased after the workflow redesign and incorporation of social determinants of health screenings and referrals in 2022 to monthly percentage of patients: May (13%), June (14%), July (8%), August (11%), September (7%), October (16%), November (8%), and December (10%). Additionally, 40 referrals were placed for additional SDOH services.
Implications for Practice: Incorporation of SDOH screening for outpatient diabetic foot ulcer patients can improve the total care of the patient by addressing individualized patient needs, while at the same time decreasing hospital admissions. The clinic will continue to monitor this data and opportunities for improvement.
Document Type
Oral/Podium Presentation
Publication Date
11-15-2023
High risk for readmission criteria for wound care patients
Background: The most common reported complication of diabetes mellitus is diabetic foot ulcers. Outpatients with diabetic foot wounds are at an increased risk for all cause hospitalization. Moreover, diabetics socioeconomic status has been shown to influence health outcomes associated with disease management.
Local Problem: At a Midwest quaternary medical center, within the outpatient wound clinic and Aurora Limb Preservation Program (ALPP), the 30-day hospital admission percentage for patients with diabetic foot ulcers was elevated in January 2022 (16%) and February 2022 (19%).
Method: A quality improvement project, utilizing A3 methodology, was initiated to proactively address patients’ social determinants of health (SDOH)and decrease hospital admissions for this population to less than 12% of monthly percentage of patients seen in ALPPs. The project included a redesign of outpatient limb preservation diabetic foot ulcer patients workflow with the addition of incorporation of social determinants of health screening questions on patients that scored 65% or higher for readmission in March of 2022. The questions specifically target physical activity, transportation, housing, financial and resources, food insecurity, and social connections. Referrals are provided for diabetic education, home health, financial counseling/advocates, and community-based case managers. Patients are asked screening questions each visit, and issues are addressed immediately in the clinic to assist with individual patient needs.
Results/Conclusions: Hospital admission for these patients decreased after the workflow redesign and incorporation of social determinants of health screenings and referrals in 2022 to monthly percentage of patients: May (13%), June (14%), July (8%), August (11%), September (7%), October (16%), November (8%), and December (10%). Additionally, 40 referrals were placed for additional SDOH services.
Implications for Practice: Incorporation of SDOH screening for outpatient diabetic foot ulcer patients can improve the total care of the patient by addressing individualized patient needs, while at the same time decreasing hospital admissions. The clinic will continue to monitor this data and opportunities for improvement.