Electronic system takes time and patience

Ensure staff, referral sources understand system

Switching to an electronic discharge system was a culture shift, not only for Charleston-based Medical University of South Carolina (MUSC) staff but for local providers as well.

"It was confusing to the local facilities that the Medical University of South Carolina was sending out placement inquiries through an outside provider," says Lynne S. Nemeth, RN, MS, director of care management, research, and evaluation at MUSC.

Nemeth made appointments with the directors and administrative coordinators of local post-acute care providers, told them about the eDischarge system, and introduced them to her vision.

"Our vision was to reduce length of stay, to reduce the time it takes the staff to make a referral, and to improve the facilities’ ability to make a decision about acceptance based on the information we provide," she says.

The hospital held information sessions for local providers before they went live.

"It was a little bit of a push to get them to consider it. They had to become eDischarge members to communicate electronically. The smaller facilities had concerns about paying more money to get our business. It took a little time working with them," Nemeth says.

Often, the receiving facilities feel like they need to see the patient. "We assured them that we were providing them with the assessment of a masters’-prepared nurse care manager or social worker who would present the patient’s needs accurately and objectively using the NASPAC assessment form, [developed by the National Association of Subacute and Post Acute Care]. We wanted to improve our ability to communicate with them and to develop a sense of trust," Nemeth adds.

The hardest part about the transition is the elimination of personal relationships between the staff and the people at the facilities to which they refer patients, Nemeth says.

"The staff were working on relationships. Now they’re working on facts. In a way, I view that as positive. It’s great to have good relationships, but it doesn’t ensure that everyone has an equal chance," she says.

The staff at Sentara Virginia Beach generally were enthusiastic about the program, says Julie M. Miller, RN, BSN, manager of continuing care.

"I was more fearful than I needed to have been about the case management staff using it. The learning curve was steep, but it has been truly embraced. All those back-and-forth phone calls and multiple faxes led to frustration," Miller says.

She suggests that other facilities develop champions for the new system who can support its implementation with the case management and social work staff.

"If a few staff members are enthusiastic about the system, it flows through to the rest of the department," Miller says.

She has some additional advice on setting up an electronic discharge system:

  • Involve your information technology people to make sure that you have the equipment and speed you need to handle the transmission of data.
  • Make sure your infrastructure is ready and that the interfaces you choose will work appropriately before going live.
  • When you are setting up the system, make sure you carefully think through and request the interfaces you need.

After using the electronic discharge system for nine months, Miller says she should have explored an interface with the hospital’s demographic and financial information system more thoroughly.