As seen in Chicago Hospital News
Published October 2009
By Corinne Haviley, RN, MS, Associate Chief Nursing Officer, Central DuPage Hospital and
Janet A. Davis MSN, RN, NEA-BC, FACCA, Associate Chief Nursing Officer, Central DuPage Hospital

Care Coordination processes and practices have long been recognized as highly variable across hospitals. Central DuPage Hospital specifically identified that current care coordination operations lack clarity regarding role definitions and consistent throughput processes. Inconsistent coordination, collaboration and standardization among team members have lead to inefficiencies impacting upon care delivery and financial outcomes. The scope included admission to discharge process of all in patient admitted to the pilot project units regardless of the point of entry. The goal of this project was to develop an organization wide operating model that provides infrastructure to support optimal patient throughput. The intent was to deliver a clearly defined operating model including roles, systems, tools and consistent processes.

The Care Coordination Department’s goal was to establish a set of processes that facilitate patient throughput including Case Management, Utilization Management (UM) and Social Work. Three initiatives were trialed through a demonstration project conducted over a six week period on two medical surgical inpatient units to test modifications to three major components of the Care Coordination process:

New Admitting and Registration Processes to facilitate accurate and timely patient demographic, social and payer information

• Consistent staff were partnered for the pilot to test the process and identify key success factors
• UM and registration staff debrief with management support/participation
• Participants capture any gaps or issues related to people/process/equipment/education needs

Reorganization of Care Coordination Roles to elevate focus on Case Management and increase efficiency and efficacy of Utilization Management

• Clearly defined roles for each member of the Care Coordination team
• The Case Manager coordinates and facilitates daily Rapid Rounds and is directs all case management activities. The Utilization Manager screens all patients for medical necessity and insurance/financial resources.
• Multiple daily “check-in” conversations occur throughout the day

Implementation of Consistent, Daily Rounds to drive earlier discharge, improved communication processes and decreased variation from unit to unit

• The daily Rounding processes include morning bed-side nursing shift hand-offs, multidisciplinary Rapid Rounds and afternoon “check-ins.”
• Rounds follow a defined daily schedule as seen below:
  
  • 7:00 - 7:45 AM: Nursing Bedside Shift Report
  • 10 - 11 AM: Case Managers and Nurses conduct Rapid Round Conference with their multi-disciplinary counterparts. All patients reviewed.
  • 2:00 PM: Afternoon "check-in" rounds begin: Nurse Managers / Charge Nurses and Case Managers are available to conference. Multi-disciplinary counterparts may join when available
  • 2:30 PM: Afternoon "check-in" rounds completed

Early Outcomes of the Care Coordination Demonstration Project, suggest that there has been realized daily action plan for each patient. Consistent, regular communication regarding each patient’s status, emphasizing early identification of a patient’s discharge needs and facilitation of the discharge plan, reinforcement of the collaborative relationship and shared responsibility for patient throughput with other members of the care team, including development of strategies to address difficult patient situations. Additional benefits have been identified as including “just in time” teaching and staff education along with facilitation of unit coordination and staff planning to most efficiently and effectively provide care. Staff have further commented:

• “Prior to this project we would never achieve this type of staff accountability”
• “The Rapid Rounds are helping us identify patients and families that can benefit from a care conference.”
• “We are identifying procedures, like that CT scan earlier this week, which are not appropriate for an inpatient stay and are now being done after discharge as an outpatient.”
• “We’re thinking ahead and acting on discharge needs earlier in the day.”
  Preliminary results indicate improved discharge times:

Unit # One
Percentage of Patients Discharged before 3 p.m.:

• FY09 Q4: 39%
• August 2009: 45%

Unit # Two
Percentage of Patients Discharged before 3 p.m.

• FY09 Q4: 39%
• August 2009: 43%
   
  The future intent of this project is to partner with Admitting and Registration to develop an aligned process for the acquisition of accurate patient demographics and payer information. Additionally development of a new Integrated Plan of Care model for house wide adoption is anticipated. It is expected to finalize a set of best practice discharge tactics to be tested and perfected for deployment across all units.