Rehab hospital finds missing puzzle piece

Patients benefit from fast transfers to subacute unit

Administrative staff charged with finding a way to improve communications between staff and a patient’s insurer discovered the missing piece of their puzzle in case management.

Although the program — called care coordination — was implemented just four months ago, staff at the Rehabilitation Institute of Chicago (RIC) already are seeing patients transferred to different units faster, says Kate Brennan, RN, BSN, director of admitting and case management at RIC.

"If a patient needs a different level of care, we can move them more quickly, whether it’s from acute to subacute or vice versa," she adds.

Care coordination will allow RIC to move patients unable to tolerate three hours or more of therapy to the subacute unit faster because communication among staff is more coordinated. "We’ll be able to move patients [to subacute care] in a matter of hours if a bed is available," notes Brennan.

"We had utilization review, admission, and discharge planning, but we needed a piece to pull it all together, and we needed to communicate with the payers, so we came up with a system that accomplishes all our needs," she says.

Care coordination for RIC is administered through two staff positions. A case manager supervises utilization review and communication with the patient’s payer and family. A care coordinator supervises the clinical care and ensures communication among the therapists, nurses, and medical staff.

RIC first plans to test the case management program at its main facility in Chicago and then expand the program to its three other facilities providing subacute care.

"We want to work out the kinks first before expanding it. Then we’ll look at expanding it into our outpatient services," adds Brennan.

A staff of six case managers and 10 care coordinators are in place at RIC’s main campus, which includes a 40-bed subacute unit.

Positions not limited to nursing

RIC’s six case management positions are not limited to clinical staff, and they comprise nursing and social services staff, notes Brennan.

"The case managers communicate with third-party payers. They also work with patients and their families to understand benefits and services provided under their insurance or Medicare or Medicaid. This is not a bedside function, but they do communicate with the family," she adds.

Care coordinator positions are filled by nurses or advanced practice nurses, notes Brennan. Care coordinators ensure that patients receiving therapy follow the therapist’s recommendations on the unit by informing the nursing staff of the therapy recommendations.

"They also work with the physiatrist and perform any necessary patient education," Brennan adds.

Improves patient services

Care coordination is one of several new programs for RIC, part of an 18-month $37.2 million redesign project. RIC is restructuring traditional discipline-based therapies into mixed-use spaces on patient floors in an effort to bring services closer to patients.

The care coordination program also includes the development and use of eight clinical pathways called clinical protocols, notes Chris Frommelt, RN, BSN, project support specialist at RIC. The clinical protocols were implemented in mid December.

"The goal was to have at least one protocol in place for each of our programs. Each protocol development team is allowed to develop others based on need, says Frommelt. A protocol is in place for use in the following programs:

• spinal cord injury;

• head injury;

• general rehabilitation;

• orthopedic amputation;

• pediatric rehabilitation.

Care coordinators place patients on protocols following admission if they meet criteria specified in a facilitywide inclusion/exclusion system.

"We’re having the care coordinators look at the criteria again to see if it’s too stringent because we’ve had fewer patients placed on the protocols than we anticipated. We need to determine what parts of the criteria are excluding potential patients," Frommelt explains.

A steering committee composed of a care coordinator, case manager, and social worker is currently determining how often the multidisciplinary care teams should meet. "We’re also looking at how to expand [care coordination] to the subacute settings in our other facilities," says Frommelt.