Swing shift case managers start work at 2 p.m. at UCLA Health and facilitate discharges that need to occur late in the day.

  • An occupancy rate that consistently is 95% or higher makes it imperative for the hospital to have good patient throughput.
  • Day shift case managers refer cases with last minute details that could delay the discharge until the next day.
  • The swing shift case managers cover the house and divide up the pending discharges among themselves.

Faced with patients who were ready for discharge but were staying overnight due to glitches and holdups, UCLA Health developed the position of swing shift case manager to facilitate discharges that occur late in the day.

“We had a significant number of patients whose discharges were being held up at the end of the day due to details that had to be handled after our regular case managers went home. Our organization is experiencing high occupancy on a daily basis, and we needed to get these patients out in a timely manner so we could get more patients admitted,” says Marcia Colone, PhD, ACM, LCSW, system director for care coordination at UCLA Health in Los Angeles.

UCLA Health includes two acute care hospitals: Ronald Reagan UCLA Health, a 520-bed Level 1 trauma center located in Los Angeles, and Santa Monica UCLA Health with 266 beds. The system also includes Resnick Neuropsychiatric Hospital and Mattel Children’s Hospital.

The hospitals experience 45,000 emergency department visits and 25,000 admissions each year and consistently have an occupancy rate of 95% or higher.

“Our high occupancy rate makes it imperative for us to move patients out when they are ready for discharge so we can free up beds and avoid boarding patients in the emergency department,” Colone says.

There are two swing shift RN case managers at UCLA Ronald Reagan Medical Center and one social worker case manager and one RN case manager at UCLA Santa Monica Medical Center. The case managers work from 2 p.m. to 10:30 p.m. five days a week and coordinate discharges that are referred to them by the unit case managers who are leaving at 5 p.m.

The swing shift case managers cover the house. Any of the case managers can refer a case to the swing shift staff, either by phone or email, and ask to facilitate the discharge.

The goal is to catch any issue that otherwise would be a problem and discharge all patients who are ready, Colone says.

There are myriad reasons why discharges are delayed, Colone points out. In some cases, an ambulance that is scheduled to pick up the patient doesn’t arrive and nobody calls to check on it. Other times, the case manager needs to get a decision from the family about the discharge plan and the family can’t come in until after work in the evening, or the case manager may be waiting for a call from a facility that doesn’t confirm until the afternoon.

In the past, if something happened to delay the discharge, the patient stayed until the next day.

Frequently, the case managers don’t get the discharge orders until 2 p.m. or later and depending on the complexity of the case, it’s a rush to coordinate all of the facets of the discharge, Colone says. Now the case managers, who get off at 5 p.m., can refer the case to the swing shift case managers and ask them to finish all the details.

“We think this is a game changer. The swing shift case managers are experienced staff who can make sure plans are moving along because they know what to do and who to call and can handle all the last-minute details. It has been extremely effective in making sure everything is in place for a timely discharge,” Colone says.

UCLA Health started the swing shift in November and has only anecdotal outcomes information so far, Colone says. “We do know that we have been able to correct problems and facilitate discharges that in the past would have waited until the next day,” she says.

The people who were hired for the swing shift like the hours, Colone says. The daytime case management staff loves the new arrangement because they can turn over the last minute end-of-day discharge tasks to the swing shift case managers, rather than staying late or leaving the discharge until the next day.

“My staff is raving about it. Everybody wonders how we were able to manage without the swing shift staff. The case managers who work days tried to make sure everything happened and did what they had to do, but there were a lot of things that fell between the cracks,” she says.