On-line referral system aids in Katrina aftermath

Relocations impacted process

In the aftermath of Hurricane Katrina, which hit the Gulf Coast in August 2005, the already challenging task of arranging discharges and communicating with post-acute providers became even more daunting, says Louise Bourgeois, RN, CPUR, director of hospital patient financial services at Ochsner Medical Center in New Orleans.

An on-line reservations and booking system called eDischarge that was in place just a few months before Katrina hit helped streamline that process and "made life easier," she adds.

"We've had such a different type of environment since the hurricane, with very limited [numbers of] post-acute providers," says Bourgeois, who oversees admitting, emergency department registration, and case management. "When we came back following the hurricane, we were trying to find out who was open and who was not open."

Both the hospital and the post-acute providers who were open faced staffing problems, she adds.

Discharge and placement efforts were complicated in the weeks and months following the hurricane, Bourgeois explains, because of relocation issues affecting patients and families.

"Some patients are here [in the hospital] for care, but their families are up north in Louisiana, or out of state," she says. "When those patients are discharged, they want to go where the family is."

Before eDischarge, staff had to go to the Yellow Pages in the telephone book, look up the area being targeted, and start calling providers, Bourgeois says. "Now we go to eDischarge and enter the zip code."

Her staff use the tool, a product of Needham, MA-based Curaspan Inc., to interface with post-acute providers, she adds. "They put in patient needs, area code, and zip code of the patient. We can send the request to multiple providers at one time."

If a provider in the area can accommodate the patient, staff there respond via eDischarge, Bourgeois says. One of the big advantages of eDischarge, she points out, is that the request can be sent to multiple providers at one time.

When a social worker comments that she can just as easily pick up the phone and call a provider when she has a patient who needs home health care, Bourgeois says, she reminds her that what gets complicated is what comes after that quick call.

"The next thing is, 'Well, fax over the information,' and you do that, and then you wait, and it may be two hours and then the answer is that they won't take the patient," she notes. "And you have to do it one [request] at a time."

With the on-line system, Bourgeois adds, staff can hit a button and resend the complete patient file electronically as needed. When there is a response from a provider, it is tied to the social worker or case manager's pager, she says, so they don't have to sit by the computer waiting.

Help with documentation

The eDischarge system also adds efficiency when it comes to documentation, Bourgeois adds. "Our other concern is, 'How do you document that you've given the patient a choice, that you're really evaluating the post-acute providers, and their response to the patient, and that you are giving equal opportunity to providers?"

Now, if a post-acute provider complains about not getting enough referrals, she says, Ochsner staff can pull up the information on eDischarge and show that in actuality that facility is receiving about the same number as any other provider.

When this kind of documentation had to be done manually, staff were always behind because it was not a priority, she adds. "They needed to do their work first. They were documenting their progress notes, but we often had to pay someone extra [to do the additional documentation]."

While the system is in use throughout her department, Bourgeois notes, "we still have a little ways to go with it" on a facility-wide basis.

Efforts are under way to extend eDischarge to social workers who report directly to the transplant and oncology departments, and to ED case management staff, she says. "We really would like to track all of our post-acute placements."

(Editor's note: Louise Bourgeois can be reached at Lobourgeois@ochsner.org. More information on eDischarge is available at www.curaspan.com.)