Centralized access unit is vision for the future’

One-stop shop’ will help physicians

As the University of California, Davis, Health System goes forward with the successful implementation of its preadmission discharge planning and utilization review program, Karen A. Warne, RN, manager for patient services and transfer center, keeps in mind a next step toward seamless patient access. 

"My vision for the future would be that we would take the preadmission nurse and admission support and develop a centralized access unit," Warne says. This unit, she explains, would include experts in the various avenues through which patients come into the hospital, combining the expertise that lies with the ED case manager, the transfer center, and the preadmission nurse.

Bringing together this knowledge of InterQual criteria, funding and eligibility requirements, and the probable discharge needs of patients with certain indicators, Warne says, "will support our ability to be proactive."

"The glue that holds it all together," she adds, "is the nonclinical staff who make sure the patients are registered correctly, that the primary care physician is identified, and that the authorization and payer information is accurate."

This means, for example, not just identifying that the patient has a payer for the hospital stay, but looking at the patient’s post-discharge care needs as well, Warne points out. "The patient might be ready for discharge and you find out there is no coverage for post-discharge care that are anticipated, or that the patient or family is not prepared for the post-discharge care needs."

Indigent patients, she adds, "are likely to have many challenges in their lives that make proactive planning extremely critical. It might be as simple as the need for transportation, or as complex as a lack of housing or lack of a support system."

Some people think they have insurance, Warne says, "but actually they have one of those $100-a-day hospital policies and are not aware they may have some financial responsibility for the services that might be needed."

Having the resources of a centralized access unit in one place, she says, "will provide a resource for physicians, who may not understand all the factors that should be considered in the transition of care between the inpatient and outpatient setting or in accepting an urgent or emergent admission or an acute transfer." Through the development of a "one-stop shop," Warne adds, "physicians can get assistance in arranging for care in the most effective and efficient manner."