Latest / Becker’s Healthcare Podcast / Improving Hospital Throughput, Quality and Access with Dr. Kyle Trecartin

Transcript

Improving Hospital Throughput, Quality and Access with Dr. Kyle Trecartin · Becker’s Healthcare Podcast

• 0:02
  - The strategic agenda facing hospital and health system
• 0:04
  - leaders right now is not a short list.
• 0:07
  - Growth in a consolidating market, sustainable margins in
• 0:09
  - a reimbursement environment that rarely moves in your
• 0:12
  - favor,
• 0:12
  - a tech investment cycle that demands both urgency
• 0:15
  - and discipline,
• 0:16
  - and a workforce story that is still being
• 0:19
  - written.
• 0:20
  - Eker's fourteenth annual CEO CFO roundtable brings together
• 0:23
  - more than 1,500 executive level attendees and nearly
• 0:27
  - 400 speakers across four days of sessions that
• 0:30
  - are designed to help c suite leaders benchmark,
• 0:32
  - pressure test, and sharpen their priorities.
• 0:35
  - Not in the abstract, but against the real
• 0:37
  - decisions they'll face heading into the next year.
• 0:39
  - It's the kind of event you leave with
• 0:40
  - a clear sense of where you stand and
• 0:42
  - what comes next.
• 0:44
  - So join us November second through the fifth
• 0:46
  - at the Hyatt Regency in Chicago, and come
• 0:49
  - ready to do the hard thinking.
• 0:50
  - Register on our events page at beckershospitalreview.com
• 0:54
  - by clicking on the events tab in the
• 0:56
  - upper right.
• 0:58
  - Hi. My name is Paige Twenter. I'm an
• 1:00
  - editor with Becker's Healthcare. Welcome to the Becker's
• 1:03
  - Healthcare podcast.
• 1:04
  - I'm joined today by doctor Kyle Tricartan,
• 1:08
  - chief medical officer
• 1:09
  - at Beth Israel
• 1:11
  - Hospital. Doctor Trikarten, I'd love for you to
• 1:13
  - kinda introduce yourself and tell us a bit
• 1:15
  - about your background.
• 1:17
  - Yes. Thank you. And first of all, I'd
• 1:19
  - love to thank you for inviting me to
• 1:21
  - attend the podcast today. It's a a great
• 1:23
  - honor. I'm Kyle Trecartin. I'm the chief medical
• 1:26
  - officer at Beth Israel Deaconess Hospital, Plymouth,
• 1:30
  - which is located in Plymouth, Massachusetts,
• 1:32
  - South Shore right next to Cape Cod, and
• 1:35
  - America's hometown.
• 1:37
  - I'm an emergency physician by background, and I
• 1:39
  - think this, really gives me a unique
• 1:41
  - perspective as a chief medical officer as we
• 1:44
  - really can see all the different pieces of
• 1:46
  - the health care system come together, you know,
• 1:49
  - from outpatient
• 1:50
  - to inpatient care, surgical care,
• 1:53
  - and all the social determinants of health and
• 1:55
  - how the community supports
• 1:57
  - their own community members.
• 1:59
  - I look at, my role as a servant
• 2:02
  - leader, and I really enjoy breaking down barriers
• 2:05
  - that prevent our frontline staff
• 2:07
  - from providing the most efficient, highest quality,
• 2:11
  - and least burnout producing care that they can
• 2:13
  - provide.
• 2:15
  - What are those kind of barriers that you're
• 2:17
  - constantly,
• 2:18
  - you know, trying to decrease or decline for
• 2:22
  - Yeah. Just frontline clinicians?
• 2:24
  - Absolutely. So, you know, I think demographics is
• 2:26
  - destiny in a little bit of a way.
• 2:28
  - And, you know, with the growing population,
• 2:30
  - especially,
• 2:31
  - you know, that over age 65,
• 2:34
  - you know, we're we're increasingly seeing capacity challenges,
• 2:37
  - especially,
• 2:38
  - concentrated in certain specialties. And, you know,
• 2:42
  - we're no stranger to the effects of boarding,
• 2:45
  - crowding,
• 2:46
  - and decreased access to specialty,
• 2:49
  - or diagnostic care,
• 2:51
  - and looking at ways that we can both
• 2:54
  - more efficiently
• 2:55
  - utilize those resources,
• 2:57
  - standardize
• 2:58
  - the,
• 2:59
  - demand on those resources,
• 3:01
  - and also move patients more efficiently through the
• 3:04
  - system so that we can use the capacity
• 3:06
  - that we do have,
• 3:07
  - you know, in a way that we can
• 3:08
  - serve more patients.
• 3:11
  - How are you approaching the
• 3:13
  - kind of throughput
• 3:15
  - issue, which, you know, as you said, affects
• 3:17
  - hospitals everywhere, ed boarding, ed crowding,
• 3:20
  - shortages to specialty care.
• 3:22
  - How are you kind of approaching that issue
• 3:25
  - at,
• 3:26
  - Deaconess Hospital?
• 3:28
  - Mhmm.
• 3:28
  - Yeah. So we've started a multidisciplinary
• 3:32
  - length of stay group, you know, nursing, physical
• 3:34
  - therapy, case management,
• 3:36
  - physician leaders as well. And we really are
• 3:39
  - looking at the entire care continuum,
• 3:42
  - from the time that the patient, even before
• 3:44
  - they hit our emergency department or outpatient surgical,
• 3:48
  - doors until they they leave the hospital and
• 3:51
  - even beyond as we continue to try to
• 3:53
  - keep them in... Out of the hospital prior
• 3:55
  - to to readmissions. And so we've implemented
• 3:58
  - programs such as an early mobility program,
• 4:01
  - have really,
• 4:03
  - looked at all the resources that are available
• 4:05
  - for patients post discharge and, you know, the
• 4:07
  - insurance authorization
• 4:09
  - project.
• 4:10
  - In the last year, we've decreased our excess
• 4:12
  - days per discharge by point one days or
• 4:15
  - about 13% for us,
• 4:18
  - which really feels like a big win, but,
• 4:20
  - we still have a lot of ways to
• 4:22
  - go. So we'll continue to work on these
• 4:24
  - things.
• 4:25
  - You know, I think we could do a
• 4:26
  - better job of getting patients out of the
• 4:28
  - hospital
• 4:29
  - earlier in the day. Everybody loves that 10AM
• 4:32
  - or or noon discharge.
• 4:34
  - And so I... I've really enjoyed working on
• 4:36
  - this problem.
• 4:38
  - For the rest of 2026 and maybe kinda
• 4:41
  - coaching into 2027, what do you feel like
• 4:43
  - are your top priorities, or what's at the
• 4:45
  - top of your to do list?
• 4:47
  - Yeah. So like I said, you know, number
• 4:50
  - one would be, you know, how do we
• 4:51
  - get patients
• 4:53
  - safely out of the hospital more effectively, whether
• 4:56
  - that's,
• 4:57
  - avoiding admission in the first place, standardizing
• 5:00
  - or utilization of diagnostic imaging or other testing?
• 5:04
  - Can we implement
• 5:05
  - something like a discharge lounge in order to
• 5:08
  - allow patients,
• 5:09
  - you know, who have completed their medical care
• 5:12
  - to wait until they, you know, have a
• 5:14
  - ride home?
• 5:16
  - Quality and safety is another,
• 5:19
  - you know, top priority.
• 5:20
  - We really are looking to strengthen our quality
• 5:23
  - infrastructure.
• 5:24
  - We want physician engagement,
• 5:26
  - from the physician leaders all the way down
• 5:28
  - to, you know, frontline physicians,
• 5:31
  - really understanding why patient safety
• 5:34
  - is really the most important part of our
• 5:37
  - role. You know, we we never wanna do
• 5:39
  - any harm to patients. And,
• 5:42
  - you know, when when quality or safety issues
• 5:44
  - affect patients,
• 5:46
  - you know, it can lead to the second
• 5:48
  - victim phenomenon for physicians,
• 5:50
  - nurses,
• 5:52
  - but also,
• 5:53
  - you know, leads to,
• 5:55
  - poorer outcomes for patients, increased length of stay,
• 5:58
  - and continues to to add demands on to
• 6:00
  - our health care system.
• 6:02
  - We're really looking to move towards a high
• 6:04
  - reliability
• 6:05
  - organization,
• 6:06
  - instilling just culture principles,
• 6:10
  - trying to move away from the shame and
• 6:12
  - blame,
• 6:13
  - that traditional morbidity and mortality conferences,
• 6:17
  - you know, have really
• 6:19
  - felt like it sometimes
• 6:21
  - and move towards asking the question
• 6:23
  - of how do we prevent this from happening
• 6:25
  - again and continuing to build
• 6:27
  - checklists, backups
• 6:29
  - in order to prevent
• 6:31
  - errors and make it easier for providers to
• 6:34
  - do the right thing and harder to do
• 6:35
  - the wrong thing. And, the third priority would
• 6:38
  - be around access.
• 6:40
  - BILH has our, what we call, blueprint
• 6:43
  - 2030 plan, where we're looking to provide 70%
• 6:47
  - of the care to our patients within the
• 6:49
  - community rather than academic medical centers. I think
• 6:52
  - this is really unique and resonates with me
• 6:54
  - as someone who lives, you know, in a
• 6:56
  - suburban area,
• 6:57
  - really expanding the number of services, the complexity
• 7:01
  - of services,
• 7:03
  - and the efficiency of services,
• 7:06
  - here in local communities rather than requiring our
• 7:09
  - patients to travel long distances and traffic,
• 7:13
  - for treatments sometimes that require multiple trips or
• 7:17
  - multiple visits,
• 7:18
  - really allows them to spend more of their
• 7:21
  - time doing the things that they enjoy,
• 7:24
  - bring them joy,
• 7:25
  - and fulfillment in their lives.
• 7:28
  - And so that means adding additional specialists, adding
• 7:31
  - diagnostic capabilities, but also, again, using the the
• 7:35
  - resources we have more efficiently.
• 7:37
  - This is why I think all three of
• 7:39
  - these priorities really work together. You know, when
• 7:42
  - we provide higher quality care, it allows things
• 7:45
  - to move through faster. When we provide better
• 7:48
  - access to care, you know, we can provide
• 7:50
  - better quality care with, you know, additional specialists,
• 7:54
  - you know, with with the highest,
• 7:56
  - credentials and highest quality.
• 7:59
  - And when we really improve our flow, you
• 8:02
  - know, it it allows clinicians and providers to,
• 8:05
  - you know, have the time to think a
• 8:07
  - little more, take their time,
• 8:09
  - doing that procedure,
• 8:11
  - and improve the quality as well.
• 8:13
  - On your point about, you know, kind of
• 8:15
  - the path toward being a
• 8:18
  - high reliability organization
• 8:19
  - and enforcing, like, a just culture rather than,
• 8:22
  - like, kind of a blame culture,
• 8:24
  - you mentioned, like, you know, you started in
• 8:27
  - an emergency medicine. Can you kind of, like,
• 8:29
  - give, like, a case study of what HRO
• 8:32
  - and Just Culture would look like in in
• 8:34
  - ED?
• 8:35
  - Yeah. So Just Culture,
• 8:38
  - relies around
• 8:39
  - looking at the system first and identifying that
• 8:43
  - most of the time, providers
• 8:45
  - are trying to do the right thing by
• 8:47
  - their patient,
• 8:48
  - and
• 8:49
  - we're all human and make errors. And
• 8:52
  - so, again, it's around trying to make the
• 8:54
  - system
• 8:55
  - make it as easy as possible for our
• 8:57
  - providers to do the right thing and as
• 8:59
  - hard as possible to do the wrong thing.
• 9:02
  - And so an example might be,
• 9:05
  - you know, with a a missed,
• 9:07
  - heart attack in the emergency department.
• 9:09
  - You know, we're relying on provider judgment
• 9:12
  - to examine an EKG,
• 9:14
  - determine whether or not it represents
• 9:17
  - a STEMI, and make a quick,
• 9:19
  - call to the cardiology and the cath lab,
• 9:23
  - to ensure that the patient gets access to
• 9:24
  - that care,
• 9:26
  - in a timely fashion.
• 9:28
  - But on a given ER shift, you know,
• 9:30
  - I might be seeing,
• 9:32
  - you know, 50 of those EKGs
• 9:34
  - and only have a few seconds to look
• 9:35
  - at each one.
• 9:37
  - And so a high reliability
• 9:39
  - evaluation might look at this instance and say,
• 9:42
  - okay. Is that a reasonable number of EKGs
• 9:45
  - for a provider to be looking at? Should
• 9:46
  - we be offloading
• 9:48
  - cognitively
• 9:49
  - the physician who's looking at e... All these
• 9:51
  - EKGs
• 9:53
  - and, you know, devote a resource to to
• 9:55
  - examining the EKGs?
• 9:57
  - Perhaps we,
• 9:59
  - have one provider who's seen, you know, the
• 10:01
  - sickest patients as they come in, and they're,
• 10:04
  - you know, purposefully not going to be the
• 10:06
  - the EKG reader for that day.
• 10:08
  - We could also look at technology,
• 10:11
  - such as, you know, automated systems that read
• 10:14
  - these EKGs and flag concerning findings,
• 10:17
  - so that the provider, you know, really will
• 10:19
  - hone in on concerning EKG findings.
• 10:22
  - And then also, you know, having more robust
• 10:25
  - systems where there's backups
• 10:27
  - such as, you know, using lab testing that
• 10:29
  - returns quickly so that we've noticed that the
• 10:32
  - troponin's elevated,
• 10:34
  - you know, in a more timely fashion.
• 10:36
  - And even if we miss the EKG, we're
• 10:38
  - still getting that CAF done in a a
• 10:40
  - a faster way.
• 10:42
  - I think another
• 10:44
  - example,
• 10:45
  - especially with, like, the just culture has been,
• 10:47
  - like, your revision to the peer review process
• 10:50
  - for musicians. Can you kinda delve into that
• 10:52
  - a bit?
• 10:53
  - Sure. When I started a a CMO
• 10:57
  - and talking with a lot of our physicians,
• 11:00
  - APPs,
• 11:01
  - you know, they really indicated that the the
• 11:04
  - M and M process as we call that
• 11:06
  - that time or peer review
• 11:08
  - felt very punitive. We were asking the question
• 11:11
  - at the end of the day of whether
• 11:13
  - standard of care was met or not met.
• 11:16
  - And it was interesting to me that when
• 11:18
  - we would find an error and we tried
• 11:20
  - to put into place a fix, you know,
• 11:22
  - the providers were not really,
• 11:25
  - interested or sometimes there would be some friction
• 11:27
  - or resistance into implementing a change.
• 11:30
  - And as I had a lot of conversations,
• 11:32
  - I realized
• 11:33
  - that standard of care being met or not
• 11:35
  - met is really the wrong question.
• 11:37
  - Myself as the CMO and the hospital
• 11:40
  - is really interested in asking
• 11:42
  - what happened
• 11:43
  - and how do we prevent this from happening
• 11:45
  - again.
• 11:46
  - The the first question puts providers immediately
• 11:50
  - in a malpractice
• 11:51
  - lawsuit mindset, given that's the only time that
• 11:54
  - standard of care really,
• 11:56
  - plays a part.
• 11:58
  - The second question immediately puts us on, you
• 12:01
  - know, the same side where we're all looking
• 12:03
  - at this case. None of us wanted a
• 12:05
  - bad outcome to happen or even a near
• 12:07
  - miss to happen, but we're all looking at
• 12:09
  - the case together and deciding what we could
• 12:12
  - do to prevent
• 12:13
  - the error from happening again to another patient.
• 12:16
  - And so this is,
• 12:18
  - looking at things like order sets,
• 12:20
  - reminders to to providers,
• 12:23
  - whether there is additional
• 12:25
  - staff members within the hospital that can help
• 12:27
  - a physician make the right decision.
• 12:30
  - And so we took it from, one,
• 12:33
  - changing the question, changing how we evaluate the
• 12:36
  - cases.
• 12:37
  - We made it multidisciplinary,
• 12:39
  - adding other,
• 12:40
  - disciplines such as nursing, pharmacy,
• 12:43
  - advanced practice providers
• 12:46
  - through our
• 12:47
  - our our QI process,
• 12:49
  - and we completely changed the name.
• 12:51
  - We found that when we talked about M
• 12:54
  - and M or peer review, providers were instantly
• 12:57
  - on the defensive and that had a negative
• 12:59
  - connotation.
• 13:00
  - And so we changed it to quality improvement,
• 13:04
  - and instituted all these changes.
• 13:06
  - In addition, when we have an action plan
• 13:09
  - that comes out of a review where we're
• 13:10
  - going to, you know, make a fix,
• 13:13
  - we're
• 13:14
  - rigorous about continuing to follow-up on that action
• 13:17
  - plan until it's,
• 13:19
  - brought to completion.
• 13:20
  - In the past, we had had, you know,
• 13:21
  - lots of great ideas on how we could
• 13:23
  - fix something.
• 13:24
  - But after a month, you know, we realized
• 13:26
  - that,
• 13:28
  - you know, everybody had forgotten about it and
• 13:30
  - was moving on to the next QI
• 13:32
  - thing. So now we continue to to evaluate
• 13:35
  - and checklist,
• 13:36
  - and move through all those action plans until
• 13:38
  - they're completed.
• 13:40
  - What has been the difference in results from,
• 13:43
  - you know, the M and M or the
• 13:44
  - peer review to kind of the rebrand
• 13:47
  - and remodel to quality improvement?
• 13:50
  - Mhmm.
• 13:50
  - Yeah. So I think we're seeing a lot
• 13:52
  - more engagement from our providers
• 13:55
  - and especially our nurses and our pharmacy staff
• 13:58
  - in the process.
• 13:59
  - I think we're starting to see some of
• 14:02
  - the just culture principles. I'm seeing,
• 14:05
  - providers willing to self disclose errors
• 14:08
  - and bring them up as a way of
• 14:09
  - instituting change within the organization.
• 14:12
  - We've found ways to,
• 14:15
  - bring up,
• 14:16
  - opportunities for improvement to our entire health care
• 14:19
  - system where we can make changes within the
• 14:21
  - EMR or to system policies
• 14:23
  - that I think have benefited patients across the
• 14:26
  - the entire system.
• 14:28
  - We're,
• 14:29
  - working on,
• 14:30
  - obtaining some information on provider satisfaction with the
• 14:33
  - process
• 14:34
  - and tracking action plans,
• 14:37
  - and would be happy to share... You know,
• 14:39
  - if we get some concrete data in the
• 14:41
  - future, we'd be happy to share that with
• 14:42
  - you as well.
• 14:44
  - Well, I will be checking in just like
• 14:46
  - how you all check-in to make sure,
• 14:49
  - you know, plans are coming in. I'll I'll
• 14:50
  - check-in. But, well, that's all the time we
• 14:53
  - have today, unfortunately, but thank you so much
• 14:55
  - for joining us, doctor Shrikardin.
• 14:57
  - Thank you. It was a pleasure.