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Measure these metrics related to quality
By Toni Cesta, PhD, RN, FAAN
Senior Vice President
Lutheran Medical Center
Quality outcome metrics, compiled for the entire organization, include readmissions, discharge/disposition delays, delays in service/turnaround time, patient satisfaction, and inappropriate admissions.
A readmission, under the Medicare definition, occurs when a patient is readmitted to any acute care hospital within 30 days of the prior discharge. As discussed in last month's article on reducing readmissions, a formal readmission reduction program is integral to any case management department.
In addition to looking at 30-day readmits, the department also might want to monitor readmissions same day, within 24 hours, within one week, or within 14 days. Readmissions within shorter timeframes might indicate an issue with the discharge plan. By organizing readmissions into subsets, the case managers can evaluate their discharge planning process and outcomes to determine whether corrective action is warranted.
Other metrics include:
Discharge and disposition delays.
Discharge and disposition delays are issues associated with the department's inability to transition the patient out of the hospital in a timely manner. These issues might have to do with the availability of services in the community, family issues, financial problems, or physician issues. They also might be related to the performance of the individual discharge planner. To evaluate the performance of the case management department in discharge planning, the department should consider monitoring and analyzing these issues on a regular basis.
Delays in service turn-around time should be tracked and trended. High volume delays should be reported to the appropriate department. Examples might include turn-around time for completion of tests, treatments, procedures, consults, as well as the reporting of same.
Patient satisfaction questions should be critically evaluated by the case management department to ensure that they have value in determining the effectiveness of the staff and the department. If none of the available questions relate to the work of the department, see if you might be able to add specific questions that might be more relevant. Patient satisfaction is affected by so many departments and disciplines that it is critical that the questions used are relevant and have meaning.
Inappropriate admissions have an effect on quality, patient flow, length of stay, and patient safety. Patients who do not need to be in the hospital should not be exposed to the acute care setting unnecessarily. The case management department can monitor these inappropriate admissions through its denial database by tracking the denials for "medical necessity on admission." The ED case manager can play an important role in evaluating patients during the pre-admission process and provide alternatives to admission when appropriate.