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Speeding Up Discharge Communication with Post-Acute Providers in a Crisis

by Mary Kay Thalken, RN, MBA on Apr 1, 2020

As hospital resources grow strained due to the influx of patients suffering from the coronavirus, it’s absolutely essential to keep length of stay reasonable.

That doesn’t mean discharging patients earlier than would be medically sound, but it does require medical teams to assess patients on their individual conditions. Then, when the determination is made that they’re stable enough to transition to post-acute care, that person must be transported out of the hospital quickly, thus freeing up the bed for the next incoming patient.

Without a productive discharge process, resources will become strained past the breaking point. In many areas, this is already happening. In order to help alleviate the stress on hospitals, you need to be able to communicate with post-acute care (PAC) providers quickly and efficiently.

These insights aim to help hospital staff, case managers in particular, establish expedient and appropriate lines of communication with their post-acute providers.

Embrace Electronic Communication

A fax or phone call-based discharge communication solution just doesn’t cut it in a crisis. Taking the time to fax all of a patient’s information, or setting aside critical personnel and countless labor hours so that a clinical team member can dial prospective post-acute care providers on a landline, can cost lives during the COVID-19 pandemic.

This scenario will only get worse as the lack of beds move “downstream,” so to speak, and starts to impact the post-acute providers dealing with additional patients convalescing in quarantined areas. The number of PAC facilities that can safely take on COVID-19-positive patients is already extremely limited, and these facilities’ own resources will only grow more constrained as more and more patients move through the system.

This will lead to a shortage of beds that can only be mitigated by a massive reduction in the time it takes to communicate with PACs. Instead of contacting two or three facilities, hospitals are faced with a scenario where they need to reach out to five, six, ten, etc., with those numbers escalating further depending on the locale.

Case Management and Discharge Resources  During the Coronavirus Pandemic

No hospital can afford to have their essential staff spend hours upon hours each day calling and faxing. It’s imperative that facilities invest in an electronic means of communication where they can send patient health information instantly. What’s more, that same system should enable quick receipt (30 minutes or less median time) of a ‘Yes’ or ‘No’ answer as to whether the PAC can accept the patient.

One additional benefit of this type of E-system is its utilization of the cloud, which enables team members to access the discharge software safely and securely, wherever they are, on a mobile or desktop device. Not only can this save critical time by not requiring team members to travel to specific work stations to initiate a discharge procedure, but it also limits those remote workers’ potential exposure to the virus, since they don’t necessarily have to be in the hospital to oversee patient transitions.

Harness Your Narrow Network

Your narrow network, the PAC facilities you’ve partnered with as part of an ACO, a payer arrangement or some other agreement, will be crucial during this pandemic.

Existing arrangements mean these facilities are able to establish a baseline of care, and because you keep in regular touch with them, you should have a pretty good idea of what their current resources are. Reach out to them now to see if their capacities have changed, if they’re able to accept COVID-19 cases, and what their protocols are if so.

Now is the time to harness this narrow network to its maximum in order to ensure the patients being discharged will be taken care of appropriately. And if you don’t have a narrow network? Start trying to come up with one, fast.

Hospital Staff Overseeing Patient ChartConsider Expanding Your Narrow Network

Okay, we just linked to an article all about how to narrow your network of PAC providers and explained why doing so is so important…BUT! In extraordinary times, it also might be worthwhile to explore the expansion of that network.

I don’t mean that you want to cut corners when it comes to discharging people to areas where they’ll receive appropriate care. However, in the interest of freeing up beds and getting COVID-19 patients to facilities where they’ll be properly taken care of, it might be worth considering the creation of a new narrow network.

This could be an expansion of a current network or something else entirely. Basically, you would be planning which overrun facilities are able to take on your patients if your typical go-to providers are full or unresponsive.

We might be witnessing the creation of entirely new facilities set up in this emergency for the sole purpose of helping patients recover from COVID-19. As these come online, consider plugging them into your hot lists of preferred providers so that you can quickly discharge patients as necessary.

It’s also important to note that, as you move to electronic communication, you’ll want a discharge communication provider who’s able to create profiles on the fly as they arise. If you don’t already have this capability, or aren’t sure if you do, please contact your current vendor, as this is a must-have in an emergency scenario where new, critical facilities are being set up in real time.

Communicate with Your Entire Network

We’ve heard from more than one hospital that has expressed a need to send a communication about the coronavirus and their patient influx to their entire post-acute network. Thankfully, Ensocare is more than equipped to enable this service, and we were able to work together with these hospital systems to ensure such a communication was deployed through our Transition software.

We would advise considering this kind of network-wide transmission yourself if you haven’t done so already. If you’re experiencing a sharp uptick in COVID-19 cases, or anything about your typical discharge patterns is about to change, it’s in your best interest to let this be known to all of your potential post-acute partners at once.

In addition, this will enable you to include questions within that communication about those PACs’ own capabilities if they haven’t shared such information with you yet. This could be just the prod they need to explain what they’ve done to prepare for the rapid influx of patients.

Being proactive about these communications can help you plan as you deal with the ongoing pandemic.

View Self-Care Tips for Healthcare Professionals

Train New Team Members on Your Software

Just as important as having software in place to establish electronic communications with PACs is having staff capable of using that software to its utmost potential and standardizing your workflow.

Have your regular users immediately start to train anyone who could conceivably take on the responsibility of helping to discharge patients. If you’re hiring more staff to help with the virus, that’s great! This could even help you free up nurses typically responsible for the administrative tasks associated with discharge to do more clinical work while non-clinical staff take over discharge communication.

If you’re not hiring more staff, then we’d still encourage you to think about who could take on the additional duty, particularly if your clinicians can be better deployed elsewhere.

Establish Follow-Up Parameters with Case Managers

Finally, you should have protocols in place for contacting patients and their post-acute care providers after they’ve been discharged from your facility.

The last thing you want in this scenario, where beds and personnel are at a premium, is to have a patient you discharged be readmitted to your hospital. If this happens in large numbers, it can make an already precarious situation even more dangerous.

Having case managers check in with PACs, patients and patients’ family members at regular intervals can help you identify signs that the patient may be backsliding in their recovery path. In those situations, you can connect them with the prescriptions, medical devices, clinical experts and other resources they would need to prevent a readmission.

If you haven’t done so already, figure out follow-up parameters and be willing to adjust on the fly as patterns begin to emerge.

A Brave New World

We’re all coming to terms with the impact the coronavirus is having on the healthcare system. But one step we can’t ignore is the essential communication that must happen between acute and post-acute providers.

Hopefully, the above ideas will help you free up beds, decrease length of stay, and assist the highest number of patients in the best way possible. And if you need any help with anything or have any questions about the topics we’ve covered, please don’t hesitate to reach out to us.

Thank you for everything you do during this troubling time.

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Meet the Author

Thalken brings more than 30 years of experience in health-care leadership to our company. Prior to joining the company, she served as Enterprise Vice President for Care Logistics in Atlanta, Ga. She has held executive leadership positions at hospitals in Nebraska and Iowa, including the position of System Quality Executive for Alegent Health. Thalken has presented on the topics of improving quality, patient flow and throughput at various industry conferences and webinars. Thalken holds an MBA from the University of Nebraska at Omaha. She is a member of the American College of Healthcare Executives, American Organization of Nurse Executives and American Case Management Association.

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