1. Winnebago Mental Health Institute Readmission Rate Project
Project workgroup
Change Leaders: Kim Lewis, Kim Packee, Carol Thomas
Members: Phil Sweet, MD; Shanna Her, SW; Jen Johnson, RN; Miah Olson, SAC; Tina Klemmer, Admissions/Registrar; Erin Sarauer, Civil Services Director; Beverly Pezewski, HIM Director; Bonnie Purtell, QM Director
Executive Sponsor: Tom Speech Ph.D.

2. Department of Health Services (DHS) Goal
“Reduce the percentage of civil patients who are discharged and re-admitted to a state institution within 30 days, through implementing a quality improvement process that continuously identifies the causes and solutions to re-admissions”
2012 National State Hospital
Average # of Readmissions = 7.4%
2008 WMHI Avg= 7.6%
2009 WMHI Avg= 8.9%
2010 WMHI Avg= 7.8%
2011 WMHI Avg= 9.5%
2012 WMHI Avg= 7.1%
2010: Data on readmission rates were being submitted to NRI (for Joint Commission.) This data included both civil and forensic readmissions.
2011: DHS Goal -- WMHI identified readmission rates as a performance measure. Data was then separated to include only civil readmission rates.
We had just began to do our readmission analysis when the NIATx project began. We incorporated the Readmission Analysis into our project as a way of identifying if the patients who were being re-admitted were a distinct subgroup of the rest of our patients.

3. Who Is Being Readmitted and Why?
Readmission Analysis: Implemented on all civil patients discharged and readmitted within 30 days
7.4% Readmission Rate (October September 2012 Readmission Analysis Data)
1506 Total Civil admissions ( % FY)
111 readmissions
44% Youth/56% Adult
40% Male/60% Female
58%Mood Disorders/18%Psychotic Disorders/9% DD
Top 2 Reasons for Readmission
1) Aggression
2) Suicidality
October 2011: Implemented Readmission Analysis on all patients discharged and readmitted within 30 days.
111 readmissions (81 individuals)
Some individuals were readmitted multiple times, two or three times in rapid succession.
44% Youth/56% Adult
40% Male/60% Female
58%Mood Disorders/18%Psychotic Disorders/9% DD
Reflective of all civil admissions. Nothing is seeming to stand out as yet that distinguishes the Readmission group from the rest of civil admissions. We will continue to analyze.
28 of 72 Counties had individuals readmitted
Top 10 Counties with multiple re-admissions
Dane(10*), Rock(10*), Waukesha(6**), Sheboygan(6), Kenosha(5), Winnebago(5*), Outagamie(4), Dodge(4), Jefferson(3**), Fond du Lac(3*)
Top 4 Reasons for Readmission
1) Aggression
2) Suicidality
3) Environmental/Living Situation
4) Situational Stressors

4. THE CHANGE ADOPT. . .
A Crisis Plan would be completed on all civil patients that were discharged and re-admitted within 30 days.
Our Process
Our Admission Coordinators screen each civil patient that is admitted
The Admission Coordinator notifies the SW that this is a readmission.
The SW completes the Readmission Analysis immediately.
The SW, in collaboration with the patient and the county, completes the Crisis Plan prior to discharge.
Copies of the Crisis Plan will go with the patient and the county upon discharge.
October 2011: Implemented Readmission Analysis on all patients discharged and readmitted within 30 days.
Data analysis initiated to look at who was being admitted and why.
We wanted to know: Was there anything within our control that WMHI could do to decrease readmission rates?
Then WMHI joined with the counties and NIATx to begin working toward the goal of reducing readmissions.
The NIATx workgroup completed “Walk through” of WMHI Admission/Discharge process- We wanted to find out: Do we do what we say we are doing? Are our admission procedures consistent throughout units?
We then tried to discover an intervention that WMHI could implement that could make an impact on what happens after the patient was no longer with us. We decided to complete a Crisis Plan for all civil patients who have been readmitted within 30 days of discharge. We thought this Individualized Crisis Plan should be created in collaboration with patient and county. We developed a form that is a very concise and is quick and easy to use that assists the patient to identify triggers and more positive responses to crises. It also identifies who to call for help to avoid re-hospitalization. These plans could be used by the patient, their friends and family, as well as the professionals working with them. We adopted this as our intervention.

5. Next Steps
Continue to work with patients and county staff to develop crisis plans together.
Gather data/determine if Crisis Plans are effective
If Crisis Plans prove effective --Determine ways to expand their use
If Crisis Plans prove effective and we hypothesize that it will (ie result in our readmission rate remain below the national average)
Attempt to identify patients on first admission as “at risk” for continued crisis or readmissions
Use as a tool in treatment group on short term admission/discharge unit

6. Long-term Impact: Reduce 30 day readmission rate to WMHI
And along the way . . .
Learn from the Readmission Analysis Data/Crisis Plan to identify . . .
Populations at risk
Most effective aftercare resources
Specific treatment to address crisis issues.
It is yet to be determined if the Crisis Plans will have a significant impact on our readmission rate as we have not had enough time to analyze our results. But we assume it will, in addition, we can learn from our efforts to more closely target our treatment while at WMHI and in developing discharge plans to support individuals in the community.