Latest / Becker’s Healthcare - Clinical Leadership Podcast / Gena Lawday, RN, BSN, Chief Quality Officer at UVA Community Health

Transcript

Gena Lawday, RN, BSN, Chief Quality Officer at UVA Community Health · Becker’s Healthcare - Clinical Leadership Podcast

• 0:00
  Hi, everyone. You're listening to Becker's clinical leadership
• 0:04
  podcast.
• 0:05
  I'm Erica Carbajal with Becker's hospital review. And
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  thank you so much for tuning into this
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  episode
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  Today, I'm joined by Gina Lade, Chief Quality
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  Officer at UVA Community Health.
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  We'll be discussing the growing role that standardization
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  plays in care delivery today, quality and safety
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  issues that she has her eye on right
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  now, and what CMS's
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  recent rule expanding site neutral payments means for
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  outpatient quality and safety monitoring.
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  Gina, welcome, welcome. We're so happy to have
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  you on.
• 0:39
  Great. Thank you for having me, Erica.
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  Yeah. Well, do you wanna start by just
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  sharing a little bit about the scope of
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  your work and your role as chief quality
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  officer?
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  Sure. Yeah. So I'm chief quality officer over
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  the UVA Community Health Hospitals, which, includes three
• 0:55
  hospitals,
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  two in Northern Virginia, which includes
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  Prince William Medical Center in Manassas,
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  as well as Haymarket Medical Center, which is
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  located in Haymarket.
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  And then lastly, one down in Culpeper, which
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  is, of course, Culpeper Medical Center. As well
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  as that we have over 50,
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  medical groups nowadays.
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  So that is an aspect of business that
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  the community health side is growing all the
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  time.
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  Gina, do you wanna start by sharing
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  what your top priority is heading into 2026?
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  Hard to believe we're wrapping up the year
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  already, but what do you anticipate
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  will demand the majority of your focus as
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  chief quality officer in the next year here?
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  Sure. I mean, that's a really good question.
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  And, obviously, you know, with the year winding
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  down, something I've been thinking about a lot.
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  I have a couple priorities in 2026.
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  Of course,
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  I mean, I'd be remiss if I didn't
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  mention CMS team.
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  With the rollout of CMS team. We've been
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  looking at not only how we can manage
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  our
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  manage these post acute transitions will be important
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  to success with that program
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  but also more holistically on how we can
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  reduce risk to our overall perioperative patients.
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  This is obviously not a new approach. We're
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  always looking at ways we can reduce harm.
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  But it just happened to be a happy
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  accident for me that I have two members
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  of our perioperative team and our CMS team
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  steering committee,
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  which have inspired me to look at how
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  we approach harm reduction at all phases in
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  the patient care continuum.
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  You know, for example,
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  how can we restart
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  the process of reducing risk for all falls
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  in pre op?
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  Research has shown that patient education is one
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  of the most impactful interventions to reduce patient
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  falls.
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  So we're looking at, you know, can we
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  start the education in pre op? Can we
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  coordinate with the post op in inpatient
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  units to ensure that the message is the
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  same throughout the patient journey.
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  One of the other ways we're doing this
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  is we're looking at the discharge teaching that
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  we provide through the same lens.
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  We're starting
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  discharge teaching with the pre periopt team and
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  we're making sure that aligns with the
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  inpatient teams to make sure that we have
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  a standardized approach to patient education all the
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  way through.
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  The other thing I'm really looking at is
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  data transparency.
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  One of the things that my team has
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  been looking at is we've been developing scorecards
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  that show our performance in key public reported
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  metrics.
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  The intent is that these scorecards are gonna
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  be shared widely with both staff and visitors
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  in our hallways.
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  But we've also decided that in addition to
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  sharing,
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  the actual
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  key metric point. But we're gonna actually be
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  sharing the corresponding outcome and process measures so
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  that staff can see how they are impacting
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  that measure
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  as well as the impact of these measures
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  on patient outcomes.
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  So to give an example,
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  along our SEP-one bundle compliance, which I think
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  is a very normal thing to
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  post, we're also sharing now our sepsis mortality
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  and sepsis readmission rates right alongside
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  that SEP-one bundle compliance score.
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  Also alongside our CAUTI and CLABSI rates, we're
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  also sharing our standardized utilization rates in our
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  bundle maintenance compliance rates.
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  So we've only been sharing these a couple
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  months but I'm really pleased with the conversation
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  that it spurred. You know, we've gotten the
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  CNO has been really heavily involved in
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  pushing back and giving us feedback on
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  how how these metrics are reported and presented.
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  And I think it's really
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  it's really helped increase the visibility of our
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  performance in these,
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  in these, metrics.
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  Yeah. So interesting, Gina. I'm glad you mentioned
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  CMS teams model. Been such a big area
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  of of coverage and things that quality leaders
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  are really focused on right now.
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  And
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  and you mentioned just
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  education with patient discharges
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  and and fall prevention, kind of getting that
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  that started earlier in the process and,
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  kind of
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  having this model
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  raise the the importance of that even further.
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  Are you working as well, like, more closely
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  with post acute
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  providers or long term care facilities
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  to support those transitions as well?
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  We are. That's,
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  that's been an opportunity in all of the
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  areas that we have hospitals,
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  just because of the areas where our hospitals
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  are located. You know, we have, for example,
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  Culpeper. Culpeper is quite a rural hospital. So
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  we have limited access to post acute providers
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  out there.
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  But this has really been
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  motivational
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  to
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  help think outside the box a little bit
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  on how we look at our post acute
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  providers.
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  So we have begun the process of, you
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  know,
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  making those care transitions a little more smooth,
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  trying to get in place good relationships with
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  our post acute providers.
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  And it's it's probably
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  something that we're going to be working on
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  more as we go through year one of
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  team.
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  But it's it's definitely
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  shown us a huge opportunity in our care
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  transitions.
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  Yeah. Certainly.
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  Gina, I want to turn to
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  standardized care as well. I think clinical leaders
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  increasingly over the past year have
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  pointed to standardized care pathways as a lever
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  for both improving patient outcomes, but also enhancing
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  operational efficiency.
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  But this you know, there's so much work
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  that goes behind
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  being able to
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  do this effectively. So could you share an
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  example perhaps where implementing a standardized care pathway
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  helps drive improvements in patient care?
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  Yeah. So one of the ones we've been
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  working on and we're in early days, but,
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  one care pathway that we've put a lot
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  of emphasis on is actually implementing
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  an enhanced recovery after surgery or surgery also
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  known as ERAS.
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  We're probably playing a little bit of catch
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  up on this one, but we've made a
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  lot of strides in the past six months
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  to get our ERAS programs up and running.
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  And we've kind of gone all in on
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  this. We're
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  implementing it for joints, rip and lining for
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  bowels, and we're gonna be implementing it for
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  hip fractures as well very soon.
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  So I'd say we've done a lot of
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  work in the past six months to go
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  from, you know, zero to 60
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  before developing our ERAS pathways. We had some
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  elements of the protocols that were implemented. For
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  example, we had some pretty robust
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  multimodal pain management, early mobilization
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  processes. We're working with PT and those were
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  getting to be in place. But some of
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  our other elements like, you know, fluid management
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  or antibiotic usage or maintenance of normothermia
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  nutrition,
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  those were all really dependent on individual providers
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  preference or we didn't have a standardized process
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  in place, for example, in normothermia.
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  So this is something that we feel is
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  gonna be impactful. You know, we're you kind
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  of tied a little bit in with team.
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  We think it's gonna be impactful to that.
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  We think it's, you know, just gonna be
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  just impactful overall to improving, you know, length
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  of stay, fewer post .com locations, you know,
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  especially like ilias and things like that.
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  Reduced opioid use always huge priority for all
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  healthcare organizations.
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  But also will help with a smoother more
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  predictable recovery for patients. And a big element
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  of this is patient education.
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  Making sure that our patients are
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  aware of what they can expect at every
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  point in their care,
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  you know, and starting that early with things
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  like joint camp and things like that. So
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  I think,
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  it's it's probably the most important one we've
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  been working at and we're hoping that this
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  will be
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  a bit of a,
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  you know, a break in the dam for
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  all of the other,
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  important care pathways we'll need to
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  implement to truly get to where we want
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  where we're reducing variation in our care and
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  we're having a consistent product all the time.
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  Yeah. Sure. And I I imagine that the
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  ERAS pathways will go a long way too
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  in in patient experience just to your point
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  about giving patients a really firm understanding of
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  of what to expect in terms of the
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  recovery process.
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  Exactly. Exactly.
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  And we've our early early
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  turnout, you know, we've shown that,
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  people tend to like the the,
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  increase in education and the expectations around pain
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  management. I think that's gonna be a really
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  big one is that people understand, you know,
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  you can have some pain.
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  How we're gonna here's how we're gonna deal
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  with it on the other side.
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  Yeah. Certainly.
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  Well, Gina, what is one quality or safety
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  issue that you believe deserves
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  perhaps some more attention across the health care
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  industry right now and why?
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  So what I've been thinking a lot about,
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  just with, you know, how much
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  AI has
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  infiltrated
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  every part
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  of of health care and, you know, even
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  society.
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  You know, I mean, you can't go about
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  forty minutes without hearing something about, you know,
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  AI and how it's gonna be changing
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  things. But the one safety issue that I
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  think, organizations
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  and,
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  you know, vendors, everyone needs to be prepared
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  for and deserves a lot more attention is
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  is the potential of algorithm drift in clinical
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  decision support tools.
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  You know, more health care shift
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  systems are shifting to AI tools for things
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  like sepsis alerts and triage
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  and image prioritization and risk scoring. And these
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  models have the the chance or the risk
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  of losing accuracy as patient population shift
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  or documentations have habits change or adapt to,
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  you know, the
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  infiltration of AI into,
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  you know, our care how we give care.
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  I think the dangerous part of that is
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  the degradation
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  could be subtle.
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  Clinicians won't necessarily see a clear failure.
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  Just a gradual decline in reliability that can
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  lead to, you know, misdeterioration or unnecessary workups.
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  You know, the things that we are trying
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  to avoid, we're trying to increase efficiencies,
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  with AI.
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  And the other thing is is is something
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  that's all seeping on my mind a lot
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  is that, you know, unlike medications or equipments,
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  most organizations
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  may not have a defined owner for ongoing
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  AI monitoring,
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  you know, with maybe in quality. You know,
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  we we've dealt with some kind of Perry
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  AI tool Perry
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  AI tools.
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  And so I've I've seen this firsthand and
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  I think that there might be an element
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  of learning the best government structure for it.
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  As AI becomes more embedded in care, I
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  think it'll become more important to ensure adequate,
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  and the right oversight
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  continuously be validating the performance of the AI
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  products,
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  have a plate have a process in place
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  to detect drift early and make sure that
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  the tools stay safe and are trustworthy.
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  Yeah. That is a really great one around
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  clinical decision support tools, one that hasn't I
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  haven't heard a ton about. I think you
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  raise a really interesting point there.
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  Jeanne, I wanted yeah. Sorry. Go ahead. I'm
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  sorry. No. I was just gonna say I
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  was like, yeah. It's it's just, you know,
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  ever since,
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  you know, I've been talking to a number
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  of vendors around, for example, like, you know,
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  sepsis
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  tools and things like that. And that's the
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  question that I keep having is, you know,
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  if if AR AI at some point time
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  is potentially referencing AI, you know,
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  is is that a risk?
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  Oh, thanks for sharing that. Wanted to talk
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  just a little bit about a recent policy
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  as well. Obviously, CMS has passed a rule
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  expanding site neutral payments and phasing out the
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  inpatient
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  only list, another signal that we're seeing more
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  complex
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  procedures moving into outpatient settings.
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  And this just got me thinking, you know,
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  what this means for quality and safety monitoring
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  in the outpatient setting as more care is
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  moving there. So
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  what kinds of standards,
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  structures, or innovations do you believe are needed
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  to ensure there is robust oversight as more
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  care moves outside the four walls of the
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  hospitals? How should systems be thinking about evolving
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  their approach to quality and safety monitoring in
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  outpatient settings?
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  Yeah. I think this is such a great
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  question, and it really touches on, in my
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  view, you know,
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  every aspect of hospital care in a way.
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  You know, is as CMS is pushing these
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  procedures into outpatient
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  settings,
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  I think health systems need to be thinking
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  more proactively about the patients. You know, success
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  is going to be about
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  setting clear standards for which procedures can safely
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  be done outside the hospital.
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  I think very importantly, clear screening to ensure
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  the patient is truly appropriate for outpatient care,
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  having really good processes in place to make
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  sure
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  that, you know,
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  we understand
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  the risks of, you know, all of the
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  the comorbidities are coming with these patients if
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  they're being taken care of in that setting.
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  And that and we do have a a
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  roadmap for this. You know, this is something
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  that we've done in in other realms of
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  hospital
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  care.
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  But this also means that we have to
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  have a mature pre procedure optimization process such
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  as, you know, we're doing those frailty assessments,
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  getting cardiac clearance,
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  as well as having standardized
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  discharge
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  and observation requirements.
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  Again, it always comes back to,
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  you know, reducing variation in care.
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  It also means that organizations will have to
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  be a bit more mindful of these outpatient
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  care sites and ensure that we have the
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  right staffing, the right training for the staff,
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  because they potentially be doing, you know,
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  procedures have traditionally been done in hospitals,
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  equipment and rescue capabilities to make sure that
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  the staff understand,
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  you know, how to rescue.
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  Hospital leaders will also want to be sure
• 14:42
  the facilities are well integrated into your bigger
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  quality structure.
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  Make sure that they have the same levels
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  of reporting and accountability to senior leadership and
• 14:51
  the governing board. And that the oversight is
• 14:55
  comparable to that inside the hospitals.
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  Data sharing reporting is also going to be
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  you know, super important in this new reality.
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  Things like tracking,
• 15:05
  unplanned transfers, complications,
• 15:08
  38 risk admission sites. So you're making sure
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  that you're doing those course corrections,
• 15:14
  as
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  things bubble up, you know, as as tries
• 15:17
  that we might, we're not able to always
• 15:19
  see all of the wrenches that was thrown
• 15:21
  into machines sometimes.
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  Technology is probably gonna be super important with
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  this shift.
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  I mean, Organizations are going to want to
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  look into the possibility of remote monitoring
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  those remote follow-up
• 15:35
  checks on patients,
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  things like potentially having more automated follow-up calls
• 15:40
  to check-in on patients and having a really
• 15:41
  good algorithm on what gets kinda kicked back
• 15:44
  to a nurse or a provider during those
• 15:46
  follow-up calls.
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  And, you know, that because of the fact
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  that patients will be leaving
• 15:54
  so quickly after the procedure,
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  I think you can never say enough
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  about excellent education
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  patients. Patients need to understand,
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  you know, we talked about this in ERAS.
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  They need to understand what the course looks
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  like,
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  when they need to be concerned,
• 16:09
  if it deviates,
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  if you're trying to keep, you know, patients
• 16:13
  out of unnecessary
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  ED visits, you know, that's a metric that
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  we look at a lot.
• 16:17
  You'll want to make sure that they understand,
• 16:19
  you know, what truly is a complication and
• 16:21
  what is something that's expected to happen.
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  So I think the big takeaway for me
• 16:25
  is that organizations with one on one good
• 16:27
  on be proactive here and be thinking about
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  this stuff,
• 16:30
  on ongoing basis,
• 16:32
  making sure their teams are ready for this
• 16:34
  change, making sure they're aware of this change,
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  making sure most of all that their patients
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  ready for this change.
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  I think that, the patient education aspect,
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  you know, again, cannot be emphasized enough.
• 16:47
  Yeah. Absolutely. We touched on there's so many
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  considerations. Right? I mean, comprehensive screening, staff training,
• 16:53
  equipment,
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  so much for leaders to start thinking about
• 16:56
  and making sure that all these mechanisms are
• 16:59
  are up to par for these site of
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  care shifts.
• 17:02
  Well, Gina, thank you so much for joining
• 17:05
  me on the podcast today. It was truly
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  a pleasure to have you on to talk
• 17:09
  about a number of different things, and I'm
• 17:11
  sure we will be in touch again.
• 17:14
  Yeah. Thank you so much. Thanks again for
• 17:15
  having me, and it was it's always a
• 17:17
  pleasure to talk to you. Yeah. Absolutely. Thanks,
• 17:20
  everyone.