“Wait, doesn’t it sound like 80 percent of the juice is still left to be squeezed on that project?” said Roy Rosin, chief innovation officer at Penn Medicine.
“We think there isn’t as much juice as originally thought,” someone explained.
“And we think the juice doesn’t taste that good,” another person clarified, to a smattering of laughs in the digital meeting room.
This exchange occurred about an hour into the first selection meeting for the Penn Medicine Center for Health Care Innovation’s flagship program, the Innovation Accelerator. Leaders and staff were discussing projects vying to be accepted into the Accelerator’s 2021 class. As alluded to by Rosin, the program seeks to squeeze some juice out of the problems often considered to be impenetrable in health care. That juice comes in the form of improved patient outcomes, streamlined operations to ease the daily grind for clinicians, reducing the cost of care and wasteful spending, or all of the above. Past projects yielded novel, leading care models like a method to screen for hidden and undiagnosed mental health conditions among hospitalized patients, a program for comprehensively supporting opioid use patients, and eliminating 80 percent of high blood pressure and related readmissions among new mothers.
The Accelerator is normally an annual fixture of the Center for Health Care Innovation, but there was no class in 2020. Most of the Center’s staff had been dispatched on various projects to battle COVID-19, tackling everything from enabling telehealth visits and making emergency department intake safe during the first wave of the pandemic to engineering a portable mass vaccine clinic program this year. On top of that, one of the projects from the 2019 class — a pilot program for safely administering chemotherapy at home — was fitted out to take on 10 times as many patients as initially planned. And other prior projects such as earlier discharge for new moms also became central to Penn Medicine’s COVID-19 response as safe ways to keep people out of the hospital became essential, driving expansion. You could say that the Center for Health Care Innovation was away at war.
So the mere fact that a 2021 class is being selected is another welcoming sign of the approach of normalcy. And while the Center’s extraordinary work during COVID-19 was invaluable, it was comforting to hear them talk — and get genuinely excited about — the nitty-gritty of typical health system operations and the largely under-the-radar problems, albeit in a video meeting setting.
“Being part of Penn’s COVID-19 response was energizing for our team during a difficult time, but we’re excited to return to solving big, ongoing challenges in health care,” Rosin said. “The Accelerator program allows us to work closely with clinical and business leaders designing high-value care models, so it’s fun to pick our heads back up, look forward, and engage on changing the future trajectory of care delivery.”
After that initial session, a round of interviews with finalists, input from system executives and another selection meeting, the Center chose the group of projects with which it will resume its accelerator. Over the next six months — co-sponsored by United Healthcare for the fifth time — staff from the Center’s Acceleration Lab and Center for Digital Health will work closely with the teams to gain a deep understanding of the problems they’re tackling, rapidly test potential solutions, and generate early evidence for real change. In the past, that’s included everything from applying text messaging programs to help care teams better communicate with patients or supplying them with wearable devices to keep tabs on important biometrics.
Here’s a quick glimpse of this year’s projects:
Catching Z’s: Improving Sleep for Hospitalized Neurology Patients
Team Lead: Denise Xu, MD, a resident in Neurology
What They’re Doing: Compared to when they’re home, patients sleep, on average, two fewer hours when hospitalized, which seems counter-intuitive for healing. Sleep deprivation not only negatively impacts patients’ experiences in the hospital but has been linked to poorer health outcomes. Much of this can be attributed to round-the-clock entries into patients’ rooms for vital sign checks, medication administration, blood draws, equipment refills, and more. The team hopes to devise ways that these potential interruptions of sleep can be systematically reduced or eliminated, starting with the neurology inpatient population.
Why They Want to Do It: Attempting to improve sleep for hospitalized patients is not a new concept, and there has been success in the past, but it has often not been material, sustainable nor fit firmly into the workflow of clinicians and staff. Xu related a story of talking to a nurse on the Neurology floor who had been part of one such project that resulted in signs outside of patients’ doors, alerting everyone to quiet time hours.
“He said something incredibly astute: ‘The signs are great... but you read them once, and then they just become part of the scenery,’” she remembered.
Xu said they want to focus on structural improvements and center sleep as a core tenet of recovery.
What They Hope To Move the Needle On: Increased sleep duration and decreased sleep disruptions for neurology inpatients. The team hopes to do this in a way that is scalable to an entire hospital and health system.
Big picture items they hope to decrease are rates of inpatient delirium, length of stay, and readmissions.
“More broadly, we want to change the culture of how we view and treat sleep in the hospital,” Xu said.
Reducing Admissions Among Patients Discharged with Enteral Nutrition
Team Lead: Kristen Dwinnells, clinical manager, Clinical Nutrition Support Services at the Hospital of the University of Pennsylvania (HUP)
What They’re Doing: When a patient is unable to eat with their mouth and requires sustenance administered through a tube that runs into their body, that is known as enteral nutrition. Each month, 80 patients are discharged from HUP requiring this treatment. This population has grown over the last decade, and these patients are 40 percent more likely than the average patient to be readmitted within a month. To improve these outcomes, the team will explore drivers contributing to the poor outcomes — ranging from patient comprehension to compliance barriers and continuity of care for inpatient to outpatient care transitions.
Why They Want to Do It: “Almost all our dietitians have heard stories of patients who were sent home on enteral nutrition only to have no support and unanswered questions, eventually experiencing failures with this therapy,” Dwinnells said.
She said that while Penn Medicine’s registered dietitians can provide support immediately after discharge, long-term outpatient programs couldn’t be established. When given a chance to look at the readmission data on their enteral nutrition patients, Dwinnells said they were both “excited and fearful” of what they might find because they knew there was a problem but also a significant opportunity to help.
What They Hope to Move the Needle On: As the name implies, Dwinnells and the rest of her team want to reduce readmission rates for patients on enteral nutrition. In addition to that, though, they’re hoping to improve overall patient care and satisfaction.
Some hard measures they’re looking to make headway on include hydration status, malnutrition status, and weight change. They’re also hoping to stabilize lab values for these patients.
“From a patient perspective, we want them to be beyond satisfied with the care and support they receive from Penn Medicine, and confident that their medical and nutrition needs and goals are being met,” Dwinnells said. “We want our patients and their caregivers to feel comfortable, confident, and, above all, to keenly understand and be able to easily follow their nutrition plan.”
Optimizing Gynecologic Oncology Care
Team Leads: Nawar Latif, MD, an assistant professor of Obstetrics and Gynecology, and Leslie Andriani, MD, a clinical fellow in Gynecologic Oncology
What They’re Doing: This team hopes to develop a standardized protocol for care for patients with gynecological cancers, improving their outcomes. These patients account for more than 160 surgeries monthly — and more than 400 chemotherapy visits. Almost half of the patients in this population at HUP also come from communities with disproportionate levels of economic need. On top of that, roughly one in 10 need to be readmitted after their surgery due to complications that arise after a return home.
Why They Want to Do It: Currently, there are no local or national standards for post-discharge care for these patients, so the opportunity to step into this vacuum was compelling.
“We know from work in other specialties that personalized, yet automated, communications and assessments can streamline post-discharge and between-visit care. These strategies can help identify concerning clinical matters early, and empower patients with essential information they need to heal and stay out of the hospital,” Andriani explained. “This patient population is high-risk in regard to medical conditions and complex social needs, so we hope this program will bring some equity to our patients.”
What They Hope to Move the Needle On: Overall, the team wants to cut down on gynecological oncology patients’ readmissions and emergency department visits. They’re also hoping to make care teams more accessible to patients and make the entire experience less difficult on patients going through an already difficult period of their lives.
“I would like to see an innovative, 21st-century post-surgical discharge care program that capitalizes on the available technology and uses evidence-based guidance to provide better, more accessible, and equitable care,” Latif said.