Memorial Medical Center
Exemplary Professional Practice
Psychiatric Readmission Team
Psychiatric Readmission Team (from left): Debbie Taylor, LCSW, Vicki Cruz, RN, Jesse Gutierrez, BS, Lorna Scoggins,
RNBC, MSN, Kathy Lee, MS, APN, PMHCNS-BC and Jackie O’Brien RN, BS
30 The percent in reduction of
30-day readmissions for
patients following the launch
of a Psychiatric Readmission
Team on Memorial’s inpatient
In the fall of
2010, a group consisting of two
nurse case managers, the unit’s
nurse manager, director of clinical
operations for Psychiatric Services,
a licensed clinical social worker
and a psychiatric social services
specialist convened to review the
number of readmissions on the
unit and identify possible
interventions to reduce the rate.
After conducting a literature review
and defining the data they needed
to collect, the group began
meeting weekly and reviewing
cases in which a patient was
readmitted, from any hospital,
within the past 30 days.
determined which readmissions
were avoidable or unavoidable
and evaluated what could have
been done to avoid a readmission.
Soon, the team noticed trend
in which patients were at risk
for readmission. Once they
understood who fell into that
high-risk group, the team worked
with the appropriate caregivers —
including nursing staff, therapists
and physicians — to ensure they
had the appropriate tools needed
to best prepare and educate their
patient for discharge. The team
began measuring their progress
in the second quarter of fiscal
year 2011 and quickly saw their
avoidable admission rates decline
as the result of their work.
Labor Induction Compliance
65 The percent improvement in compliance with
labor induction bundles since implementation on
the Family Maternity Suites.
This four-part bundle is intended
to protect both the mother’s and baby’s well-being by requiring
that all four steps be met before an elective induction is initiated.
These include: ensuring the baby is at or past 39 weeks’
gestation; fetus status is normal before introducing Pitocin;
a pelvic exam is completed; and the absence of uterine
tachysystole. Research indicates taking these steps provides
better outcomes for the infant, especially if the induction occurs
after the 39-week mark.
FMS has been 100-percent compliant
in not allowing elective inductions prior to 39 weeks since January
2011. The unit also has seen improvement — 83 percent — in
compliance to its four-part labor augmentation bundles since
2009. This bundle has the same criteria as the induction bundle
but does not take into account gestational age if a mother has
gone into spontaneous labor prior to 39 weeks; instead, the team
considers the estimated fetal weight before deciding whether to
augment the labor with Pitocin.
Heart Failure Support Team
Heart Failure Support Team (from left):
Marilyn Prasun, PhD, CCNS, CNL, FAHA, Valerie McKnight, BS, Brandy Dennis, RN-BC, CHFN, Tracy Kesinger, RN,
MS, ACNS, BC, Erin Nelson, RN, BS, Kimmie Crawford, BSN, RN-BC, Becky Smith, RD, LDN
9% The 30-day readmission rate for patients who participated
in Memorial’s Heart Failure Clinic in the first three quarters
Our Heart Failure Support Team takes a proactive,
interdisciplinary team approach to preventing and treating heart
Since its implementation in 2005, the team has seen all
patients admitted for heart failure to improve their outcomes
by standardizing patient teaching in preparation for discharge,
improving compliance with core measures, and successfully
transitioning patients to outpatient management, such as through
our tele-management program and an APN-led Heart Failure
Clinic. All heart failure patients are referred to the outpatient clinic
within 10 days of discharge and benefit from the expertise of
registered nurses, a pharmacist, dietitian, social worker and
exercise specialists. Patients also can chose to participate in
monthly Heart Failure Support Group meetings, during which they
are educated on taking medications, cooking and other topics to
help achieve a better quality of life.
As a result of these efforts, our
30-day readmission rate for Heart Failure Clinic patients decreased
from 11.07 percent to 9 percent, one of the lowest rates reported
nationally. Length of stay also has decreased for these patients.
Memorial Stroke Center
458 The number of stroke patients who presented at Memorial Medical Center in 2012.
Our nursing staff
and nurse leaders have led the way in developing a strong stroke program for patients, which now includes
Telestroke technology, a neurointerventional radiology program and the “Star 45” protocol for treating patients
who present in our Emergency Department with stroke symptoms.
Implemented in August 2012, Memorial’s
Telestroke program places high-definition audio-video conferencing technology at outlying facilities, with a
focus on rural hospitals, which do not typically have immediate access to fellowship-trained stroke
neurologists. The program was developed with significant assistance by a stroke coordinator, a new nursing
position implemented in early 2012. Nurses also helped develop our Star 45 program, which seeks to
diagnose patients and begin to apply the appropriate interventions within 45 minutes of patient presentation,
by looking at the process from a patient-flow perspective so that an appropriate ICU bed is available after an
intervention is applied.
Additionally, our Nursing team helped develop our new neurointerventional radiology
program by researching evidence-based practices for care of stroke patients requiring neurointerventional
radiology and collaborating with neurologists, surgeons and other providers on developing state-of-the-art
practices to best treat these patients. Memorial’s Stroke Center was recertified by The Joint Commission in
the summer of 2012, further reaffirming the quality outcomes Memorial has achieved in caring for its patients
requiring stroke care.