Software tracks dollar figure for avoidable days

When Haywood Regional Medical Center in Clyde, NC, began tracking case management interventions, staff began by looking at variances in care and documenting them to see how they could improve patient care.

Staff chose their own list of possibly avoidable days (PA days) and started tracking them.

That led to the creation of a list of reasons for PA days that eventually grew to be more than four pages long, according to Shirley Trantham, RN, BSN, CCM, director of health resource services, which is the case management department at the hospital.

In the beginning, case managers checked off their interventions on a work sheet and the office assistant entered the information into a database. The database is used to track the cost savings, based on the hospital’s charges, Trantham says. The case managers figure the cost savings based on the hospital charges. The hospital has just begun using a computer program that allows the department to print cost savings reports per patient, per case manager or per month, quarter, and year.

"If they save one day, the charges are divided by that amount by the number of days a patient is here, and the savings are calculated. Since most charges occur in the first 24 to 48 hours, it may not be possible to get an exact figure, but it gives us a ballpark figure," she adds.

The new electronic case management program was developed for community case management and was rolled out for the entire department in December. The software incorporates a pull-down list of the frequent case management interventions. "Now case managers don’t have to look at the list and find the number code. Now they go to the drop-down box and pick an intervention code, and it’s done," Trantham says.

Now that the case managers are documenting the interventions themselves, it will free up the office assistant’s time to help in other ways, she adds. "I’m sure there are a lot of interventions and PA days that we have missed. Now that the nurses don’t have to go through the list and code their interventions, it’s likely that we will document more of them."

When the case management department started producing the reports that tracked their intervention, some staff in other departments complained and referred to the case managers as "the chart police," Trantham recalls.

"We explained that the purpose is to improve patient care. It’s not intended to be punitive. Over time, everyone realized that we were trying to improve the process and prevent the same things from happening over and over again," she says.