Discharge planning system makes documenting easy

Tracking which patients go to which facilities

At Sarasota (FL) Memorial Hospital, discharge planners don’t spend a lot of time checking off boxes to document each individual task they have performed.

"Discharge planning is something that is not measured well because the case managers, psychosocial case managers, and social workers do so many things at once," says Greg Borden, CURN, CCM, systems manager of ICM/QI/ infection control.

To make discharge planning documentation easier, the hospital’s integrated case management department has created a discharge classification "value system" that rates patients by complexity of discharge on a scale of 1 to 5.

As staff enter the disposition and intervention codes, the system rates the complexity. For the most part, staff do not know what the complexity of a particular patient will be.

The system was designed to do the calculation and take the emotional aspect of deciding how complex the discharge planning was out of the equation, Borden says.

"We took the tick-mark mentality out of it. The discharge planners don’t have to mark down everything they do. We know the major highlights of what they do, and we have put a value to it," he says.

Sarasota Memorial Hospital discharge planners handle between 1,500 to 2,000 cases per month, making it almost impossible to document every little task they do on a daily basis.

When case managers have to document by checking off boxes, they often get several days behind and have to go back and fill in, sometimes forgetting what they actually did, Borden says.

"If a patient is going to a skilled facility, we know that the discharge planner needs to talk to the family and make calls to set up the transfer. They don’t need to document that in the tracking system because it happens every time," he adds.

To create the value system, the hospital designated five levels of discharges, ranging from Level 1, a simple discharge that takes about half an hour, to Level 5, a catastrophically ill patient whose discharge activities take about eight hours on average.

"The specific detailed information goes into the electronic chart. What we want to know is the complexity of the patient and what it took for discharge. We try to minimize any duplication between the chart and the tracking system," says Borden.

The system allows the department to calculate the full-time equivalents or workload and show the number of hours used in discharge planning.

In addition to quantifying the discharge planning work, the information is useful in staffing each unit, he adds.

For instance, orthopedics has a high volume, but most of the patients are low-level patients, hospitalized for planned surgery, who have everything in place before the surgery. Other units may discharge a low volume of patients who have very intensive needs, he says.

The hospital monitors the disposition of patients and takes it a step further, setting up codes to specify which home health agency, skilled facility, or rehab facility received the patient, allowing the department to track which facilities are taking which kind of patients.

"We can run reports to know which agency gets the bulk of the discharges. We know who is getting all the gravy and who helps the unfunded patients," says Judy Milne, RN, MSN, CPHQ, director of integrated case management and quality improvement.

The case managers have found the information useful when placing patients.

The hospital uses the information internally for its own skilled nursing facility, rehabilitation facility, and home health agency.

"It has helped them internally see where the marketing opportunities are. They always knew how many patients they got. Now they know how many go elsewhere," Borden says.