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ED Accreditation Update: Disease-specific certification links EDs to continuum of care, may reduce return visits by the chronically ill
Educating patients to manage chronic illnesses can reduce number of future visits
Your ED is geared toward delivering acute care to sick or injured patients, but hospitals that aspire to earning disease-specific care (DSC) certification are requiring their EDs to take a fresh look at how they treat patients with chronic illnesses.
"It’s a very different thought for the ED to look at a patient who is acutely ill, and to think of the care that they are receiving here as part of a chronic treatment program," says Joyce Masterton, RN, MS, AEC, who coordinates the asthma outreach program for the ED at Central DuPage Health in Winfield, IL.
The Joint Commission on Accreditation of Healthcare Organizations began accepting applications in 2002 from organizations that wanted additional recognition for the disease management and chronic care services they provide. The DSC certification is awarded to an organization’s chronic disease management program specifically, but hospitals that have attained the certification say ED buy-in to the process is critical, because it often is the portal to the chronic disease program.
Training ED staff to look at the patient’s chronic illness, and not just at the acute exacerbation (asthma attack, etc.) currently at hand, has been a challenge, Masterton says.
"It’s a completely different way to think," she says. "Our whole theme has been to change practice patterns in all settings, so we provide education in the ED, and do [primary care] office site training, all to train how to manage the patient more aggressively and effectively. It’s a good continuum-of-care process."
After more than 15 years of trying to get respiratory therapists assigned to the ED, Central DuPage piloted a program, Masterton says.
"For 16 hours of coverage, seven days a week, therapists from the respiratory department are housed in the ED," she explains. But there is not always a respiratory emergency in the ED, so these ED respiratory therapists are also trained to take lab samples, conduct electrocardiograms, and help alleviate the regular workload in the ED during their shifts. ED management wrote the therapists’ job description so that the ED could get as much benefit from the arrangement as possible.
The ED staff receive two hours’ training each year in the basics of asthma, Masterton says, and she has drawn up an asthma template for all hospital departments, including the ED.
"It’s like a puzzle, and if any of the pieces are missing, if you do inservice with all departments or staff but miss one group, then the whole program goes down, she adds.
Melissa Zolecki, RN, asthma project liaison in the ED at Central DuPage, says having respiratory therapists in the ED, where they can do telephone follow-up on asthma patients the day after they’re seen in the ED, "has made our continuity of care so much better."
According to Zolecki, one tool created by the ED staff that has been an important asset to the asthma program is a flowsheet on which is recorded exactly how much asthma education a patient received during his or her visit. That lets the therapists know, when they make follow-up calls, how much additional contact the patient needs with the asthma education program.
At Central DuPage, when an asthma patient comes in, he or she is treated for the asthma attack that prompted the visit and also receives asthma education, all the equipment (nebulizer or peak expiratory flow meter) needed, and a referral into the hospital’s asthma management program. The next day, a respiratory therapist follows up with the patient to encourage him or her to enter or maintain an asthma management program rather than waiting until the next attack and returning to the ED.
While providing more than acute care might take a bit more of the ED staff’s time, the payoff in the long run is that that patient might not return time after time for the more expensive ED care.
Masterton points out that the ultimate payoff for Central DuPage’s disease-specific program shows in the drop in pediatric admissions for asthma exacerbations. "We’re able to keep many more patients out of the hospital and out of [return visits to] the ED, so of course that has made the lives of the ED staff easier," she says.
"The ED is the most expensive place [to receive treatment], and when the patients are treated acutely, they feel better and they think they’re better, so they aren’t encouraged to think of it as a chronic disease," Masterton continues. "Education in the ED, in addition to the acute care, encourages them to think of it in terms of ongoing treatment."
Currently, the Joint Commission awards DSC for more than 40 chronic conditions. About a dozen organizations have been certified since the program began. The areas of specialty in which organizations have received certification so far are congestive heart failure, chronic obstructive pulmonary disease, asthma, wound care, diabetes, and women’s health. Another 48 organizations are nearing completion of their certification process, according to Maureen Connors Potter, RN, MSN, executive director of the Joint Commission’s DSC program.
The Joint Commission and the Dallas-based American Stroke Association worked together to draft the recently announced advanced DSC certification program to evaluate stroke care provided by hospitals. Because stroke is an acute event that is a leading cause of serious, long-term disability in the United States, the ED can play an important role in educating these patients about managing their conditions, Potter explains. There are an estimated 4.7 million stroke survivors in the United States today.
DSC certification is independent of an organization’s accreditation by the Joint Commission. It is voluntary, and organizations that are not accredited by the Joint Commission also may apply.
Hospitals applying for DSC certification in stroke, for example, must identify clinical practice guidelines, performance measures; describe its stroke team and patient education program; offer relevant marketing materials; describe the mission statement and the hospital’s ethics statement; and supplies demographic information. The ED’s role in the application process, Potter adds, would be to have written protocols to demonstrate compliance with the Brain Attack Coalition’s (www.stroke-site.org) recommendations for stroke care.
Once an organization applies for certification and provides an overview of its program, goals and objectives, and clinical practice guidelines, the Joint Commission conducts an on-site review, usually within 45 days of receiving the request for certification. Based upon surveyors’ findings, certification is granted or denied within 45 days after the site visit. Denial or granting of certification does not affect an organization’s accreditation, but receipt of certification often is used by organizations in their survey process for accreditation.
A hospital not already accredited by the Joint Commission can expect to pay a $9,000 base fee to participate in the DSC certification process, while already-accredited organizations receive a 25% discount on that fee. Once certification is awarded, there is a $6,750 cost for the first year and $1,125 for the periodic performance review the second year.
For more information on disease-specific care certification, contact: