Bundle Programs Improve Care, Reduce Costs

Infographic about Health Bundles

The nationally recognized success of CHI Health’s Bundle Payment for Care Improvement (BPCI) initiatives has been a team effort that requires talented and dedicated nurses at each of the participating facilities.

A health care bundle is a structured way of improving the processes of care and patient outcomes. It includes a set of evidence-based practices — generally three to five — that, when performed collectively and reliably, have been proven to improve patient outcomes and can lower costs.

CHI Health St. Elizabeth, Mercy and Good Samaritan are leading the way in orthopedics.

Orthopedics Bundle

Christy Wagner, BSN, RN, who has worked for three years as a nurse navigator in joint and spine, said prior to starting the discharge planning of joint patients, roughly 30 to 40 percent were discharged and went directly to their homes, compared to 70 to 80 percent now.

“Plus, our length of stay has definitely trended down, so we’re able to get patients home a little bit sooner than we used to just by spending a lot more time with them beforehand and figuring out all the barriers,” Wagner said. “The patients love it — and they love that we’re calling them when they get home and that they can call us.”

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Cardiac Bundle

For CHI Health’s cardiac bundle program, nursing is also a crucial component. Once again, it starts with educating patients about their condition.

“When it comes to bundled — or any episodic payment model — one area that nurses really stand out is inpatient education,” said Stacy Cerio, MSN, RN, director of Population Health/Cardiac and Vascular West. After heart failure diagnosis, patients are encouraged to attend and bring family members to a two-hour educational “academy.” Cerio said patients who have attended the cardiac academy have less than a 7 percent readmission rate, compared to 20 to 25 percent for non-attendees.

“The feedback that we’ve had from patients is that they would’ve never retained the information had we tried to teach them in the hospital,” Cerio said. “Bringing them to a non-stressful environment and taking our time with them has really seemed to work.”

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Sepsis Bundle

CHI Health Mercy is home to a successful bundle program for sepsis, which can be a very complex condition. Unlike orthopedic or cardiac cases, sepsis symptoms can be masked by other things going on with the patient.

“Sepsis patients present with a wide range of symptoms that may or may not always be picked up in the first couple of hours, which is unlike the other bundles where it’s pretty clear cut who the patient is and exactly what their needs are,” said Denise McNitt, MS, RN, vice president for Patient Care Services at Mercy. “One of the keys to the sepsis bundle program’s success has been the nurse navigators’ ability to collaborate with the physicians to help identify those cases.” McNitt said once those sepsis patients have been identified, the nurse navigators make contact with the patient and follow the patient throughout the hospitalization to assist with the best plan for them after discharge from the hospital.

“The nurse navigator works with physicians and care managers as a second set of eyes for an appropriate plan of care,” McNitt said. “Because some of these patients are very, very sick, they really require quite a bit of coordination. The nurse navigator takes them on from the beginning, follows them while they’re in the hospital and then continues to play a role in the patient’s care for 90 days afterward.”

How sick a sepsis patient is determines whether they will go home, to a skilled care facility or require home care. McNitt said recovery from sepsis can take time as well as require multiple treatment protocols — and requires nurse navigators to maintain close personal contact by phone or visits. Thanks in part to nursing, the sepsis bundle program at Mercy is working.

“Not only did we improve the care of sepsis patients, but we demonstrated cost savings. To me, that’s the key point of these bundles because if we’re not improving the outcomes of patients, we’re not meeting the true objective,” McNitt said.

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