Electronic system places patients in post-acute care

Cuts length of stay, saves time for case managers

Discharge planning for patients who need long-term care often is a challenge for hospital case managers, particularly if the patient is from another region.

They are faced with finding care for a complex patient in another state where they are likely to have limited knowledge of referring facilities.

As a result, the discharge planning process can involve a lot of research and literally hours of faxing documents and calling back and forth, often delaying discharge from the acute care hospital.

Case management departments in two hospitals that frequently treat seriously injured vacationers and other patients residing in a wide geographical area are among those who have found a solution to their discharge planning needs by contracting with an electronic discharge planning system that provides secure, Health Insurance Portability and Accountability Act (HIPAA)-compliant communication via the Internet with post-acute facilities all over the country.

"It’s all part of our vision to improve patient flow, to know our outcomes, and to have the resources to get the patients to the right location at the right time," says Lynne S. Nemeth, RN, MS, director of care management, research, and evaluation, at the Medical University of South Carolina (MUSC) in Charleston.

Making a complex process a lot easier

In one example, using an electronic discharge planning system turned what once would have been a long, tedious process of finding care for a complex patient in another state into an easy process, says Kim Egbert, RN, MSN, a care manager at MUSC.

The patient, a resident of New York state, traveling in South Carolina, was in a motor vehicle accident that left him a ventilator-dependent quadriplegic with no funding for long-term care. The family wanted him discharged to a facility near their home.

Egbert sent out more than 80 referrals in a matter of a few minutes and over the next few days received replies from several facilities that were not just willing but eager to admit the patient.

"I was able to place him with no difficulty at all," Egbert says.

In the first six months that Sentara Virginia Beach (VA) General Hospital used an electronic discharge planning system, eDicharge from Newton, MA-based CuraSpan, the case managers were able to decrease the length of stay for patients transferred to skilled nursing facilities by 0.3 days.

"Over time, we expect to see the overall length of stay decrease. Now with the capability of placing skilled nursing facilities patients more efficiently by eDicharge, the case managers have the time to work on the complex cases," says Julie M. Miller, RN, BSN, manager of continuing care at the hospital.

Time savings are harder to quantify, Miller says, adding the case managers report that it is much less time-consuming to complete placements.

"We were spending a lot of time faxing multiple documents and making multiple phone calls back and forth to long-term care facilities, rehabilitation facilities, and skilled nursing facilities," says Dee Paske, RN, CCM, nurse case manager at Sentara Virginia Beach. Finding post-acute care for an out-of-state patient usually means calling the family physician, asking for suggestions, and doing a lot of research before locating a facility, she says.

Both hospitals have a contract with CuraSpan, a provider of connectivity and network management, for its eDicharge platform discharge planning solution.

The system allows the case manager to enter the city, state, and zip code into the eDischarge database to find available facilities and resources where the patient chooses to receive care.

The hospital case managers use an electronic version of a state-mandated or other screening form, including the NASPAC form, developed by the National Association of Subacute and Post Acute Care, in addition to providing demographic, financial, and diagnosis information.

Case management staff can simultaneously send out 10, 15, or even more inquiries with an electronic discharge planning system when they might have sent out two or three if they had to fax the information to one facility at a time.

A facility using the eDischarge system uses it for all referrals, whether they are local or out of region. The electronic discharge system has been of the greatest benefit when it comes to finding post-acute care for difficult-to-place patients, Miller adds.

"Ventilator beds and isolation beds are hard to come by. By getting our patients into the system as early as possible, we can get them approved and on the facility waiting lists," Miller says.

The system allows supervisors to track referral patterns, such as how many referrals are sent to a certain facility and how many were accepted, Nemeth adds.

"Overall, it’s a better way to evaluate the business outcomes. As a director, I can evaluate the outcomes and interventions of my team," she says.

"When we have a full house and the administration asks what we are doing to open up beds, I can show them how many referrals went out and what we are doing to manage patient flow," Nemeth explains.

(Editor’s note: The Centers for Medicare & Medicaid has set up a Nursing Home Compare site, which provides detailed information about the past performance of every Medicare- and Medicaid-certified nursing home in the country, listed by geographical area. Go to: www.medicare.gov/NHCompare/home.asp.)