Patients bypass admitting, go directly to rooms

Start evaluation within 20 minutes

When new patients arrive at Kernan Hospital in Baltimore, they go directly to their rooms and are seen by a staff member who starts the evaluation process within 20 minutes of arrival.

The decision to eliminate the admission office was made when the 129-bed rehab facility was created three years ago following the merger of Kernan Hospital and Montebello Hospital in Baltimore, both part of the University of Maryland Medical System.

"We took into consideration what the customers want. We had focus groups of former patients and current patients who gave us input. We looked at it not only from a clinical perspective but from a patient and family perspective," says Linda Hutchinson-Troyer, MGA, patient therapy manager of the brain injury unit.

Here’s how the admissions process works: Referral sources call a central referral number at the post-acute care network office if they would like to admit a patient to Kernan Hospital. The referral staff take basic demographic, medical, and insurance information during the initial call.

A nurse liaison from the post-acute care network visits the patients at the community hospital or University Hospital and obtains additional medical information that is faxed to the doctors on the unit where the patient will go for rehabilitation. The physicians at Kernan review the information, ask questions, and approve the admission based on the information they receive.

Discharge summary forwarded

At that point, the nurse liaison and the case manager from the referring facility work on a transition date into rehab.

The referring facility is asked to send the discharge summary to Kernan with the new patients.

On the day the patient is due to arrive, his or her first name and last initial is posted on an arrivals board on the unit, along with the time the patient is scheduled to leave the discharging hospital.

The senior therapists can look at anticipated arrivals and decide if additional staff members need to be assigned to the unit.

Hospital security meets the patient at the ambulance entrance to the hospital and accompanies the patient to the floor where he or she is met by the unit’s administrative associate. She directs the patient to the room and alerts the treatment team that the patient has arrived.

The patient’s evaluation begins within 20 minutes after he or she arrives in the room. If the patient arrives without a discharge summary, the unit administrative assistant calls the referring hospital and asked for it to be faxed. There is a fax machine on every unit at Kernan, to facilitate an easy flow of information.

The Kernan staff use the discharge summary for the discharging hospital as a way to reduce redundancy. For example, if a particular test was performed at the discharging facility, the therapist looks at the results and decides whether to evaluate further, rather than just routinely repeating the test.

"It’s cost-effective, but it also is expeditious and efficient for the patient," Hutchinson-Troyer points out.

Having the discharge summary helps all the staff determine the patient’s functional level without waiting for the evaluations. In the past, the staff wouldn’t let patients walk until the physical therapist had evaluated them to find out their level of ambulation. Patients would complain that they could walk to the bathroom at the other hospital.

At Kernan Hospital, planning starts before the patient enters the door.

The Kernan staff has set up a post-acute network that facilitates easy movement from one level of care to the next.

The hospital developed a form that the nurse liaisons use when they send information on patients who are to be admitted. Information includes whether the patients need a specialty bed or specialty wheelchair so the staff can have it ready when they arrive. Special medications and special care, such as suctioning, are noted.

"As part of our work redesign, we determined what we need to know about patients before they even hit our door so we can be prepared," Hutchinson-Troyer says.

At the initial team conference, the team identifies whether the patient will need care in another venue, such as an outpatient clinic or day treatment program. The case manager works within the network to start the pre-authorization so the patient will be able to move to the next step without any difficulties.


For more information on Kernan Hospital’s admissions process contact:

Linda Hutchinson-Troyer, Kernan Hospital, 2200 Kernan Drive, Baltimore, MD 21207. Telephone: (410) 448-2500. Fax: (410) 448-6253. E-mail: LHTroyer@