Staff move patients through the continuum

Daily dashboard monitored throughout the day

At Good Samaritan Hospital in Baltimore, support staff collaborate with case managers to follow up on tests, consultations, evaluations, and other procedures, making sure anything that could impede a patient's progress is carried out in a timely manner.

On a "daily dashboard" on the electronic case management system, case managers enter "rate-limiting" procedures that have to be performed before the patient can move to the next phase of care. The support person monitors the dashboard throughout the day and contacts the ancillary department whenever a procedure has to be completed before the patient can progress in treatment or discharge.

"In many places, case managers simply identify delays after they happen, retrospectively. We are taking that same reporting process to a concurrent level. Most often these delays surface because of poor orchestration or scheduling," says Steve Blau, LCSW-C, director of case management.

Case managers are good at identifying medical management barriers that impede a patient's progress, but they don't have enough time to communicate with all the ancillary departments necessary to get all of the tests and procedures completed to keep patient flow moving, he says.

"If case managers have to make a number of phone calls to get any number of consults started and also have to negotiate a patient's place on an ancillary department's schedule, they don't have time to see their patients. This system allows them to identify a problem and signal through an automated system for the support person to follow up," he says.

The case managers use their clinical judgment as to what priority the procedure should have. For instance, a patient who needs a physical therapy consult and is expected to be in the hospital for a couple additional days will have a lower priority than a patient who is closer to discharge and the same evaluation is necessary to determine an appropriate disposition.

"Whatever operational barriers exist, we are making sure the staff are alerted. We have the clerical staff make the calls because the case managers simply do not have time," Blau says.

Good Samaritan's support person has a high school education, computer skills, and "incredible people skills. She networks with the clerical staff in other departments and makes it work," he says.

When the case manager indicates that a procedure needs to be performed quickly, the clerical person in case management contacts the clerical person in that department and takes an active role in making the appointment and ensuring that the patient is moved up on the schedule.

Without smart systems, people who work in the ancillary departments don't always have a clear understanding of patient priorities and often take patients in the order that the orders for procedures come in.

"Ancillaries are only as effective as the system that is in place to help them be effective. We challenge them to think about their schedule and give them the information they need so they can meet the priorities of the hospital," he says. The goal, ultimately, is to provide timely information to allow ancillaries to self-organize around patient needs and priorities.