Every patient who enters a hospital is different, and there are definitely some who are easier to treat and release than others. For example, a young, otherwise healthy woman with pneumonia who responds rapidly to antibiotics and has plenty of family support might be in and out of the hospital relatively quickly, discharged home with a care plan and a follow-up phone call. On the other hand, an 80-year-old woman with pneumonia who also has asthma and requires skilled nursing may be more difficult to move out of the acute setting. In this case, the patient may linger in the hospital while care coordination staff work to identify the next care facility. This can lead to an extended length of stay, resulting in higher care costs, potential quality risks and an increased likelihood of negative patient perceptions.
However, by leveraging robust care coordination technology, hospitals and health systems can smooth the discharge process for those “hard-to-discharge” patients. Early in the patient’s hospital stay, physicians, nurses and discharge staff can begin discussing potential post-acute care needs with the patient and family. As discharge draws closer, staff can enter details relevant to the individual’s needs into a care coordination solution and simultaneously send requests to multiple post-acute providers that match the patient’s requirements. The organization then receives responses from providers to determine if they are able to accept and appropriately care for the patient. From here, the discharge staff can discuss the various options with the patient and family and help them make the best selection. Once a facility is chosen, the discharge staff can send easily-digestible portions of the patient’s medical record to the receiving facility so it is well-informed about the patient’s care needs and can prepare for the individual’s arrival. This clear and continuous information exchange prevents care gaps and also makes the patient feel more comfortable and welcomed at the new facility.
While all patients are not the same, everyone can experience a straightforward and seamless discharge process. Through care coordination technology, organizations can increase transparency, improve efficiency and elevate communication, ensuring the patient rapidly and successfully transitions into the next level of care.
To learn more about how care coordination solutions can better manage those ‘hard to discharge patients’, read this article by Dr. Mark Kestner at Community Regional Medical Center, an Ensocare hospital client.