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Beth A. Duthie, RN, PhD, director of patient safety at NYU Langone Medical Center, wasn't surprised by findings in the study "New nurses' views of quality improvement education" published in the Jan. 10 issue of The Joint Commission Journal on Quality and Patient Safety.
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She watched the young nurse getting chastised for making an error and could see the fear in her face as her manager's voice rose in anger. The young nurse was put on indefinite leave. That's what happens when you make mistakes, she thought to herself.
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The Centers for Medicare & Medicaid Services (CMS) in 2007 stipulated a five-year period in which verbal orders must be "dated, timed, and authenticated promptly by the prescribing practitioner or another practitioner responsible for the care of the patient, even if the order did not originate with him or her.
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It's nothing new. Compliance with verbal orders has been a struggle for hospitals for more than 25 years. Many experts Hospital Peer Review spoke with compare verbal-order compliance to hand-washing compliance. It's behavioral. It's something we know we have to do. And it's not a matter of ill-intentioned practitioners. It's a matter of time and logistics.
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Case managers typically have concentrated on what has to happen before the patient can be discharged from the hospital, but now, to reduce readmissions, hospitals also have to take into consideration what happens to patients after they leave the acute care setting, says Beverly Cunningham, RN, MS, vice president, clinical performance improvement, Medical City Dallas Hospital, and health care consultant and partner in Case Management Concepts LLC.
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Case managers are a hospital's first line of defense when it comes to smoothing transitions of care and preventing readmissions.
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The Medicare Secondary Payer questionnaire is not complete. The Medicare number is missing from a replacement plan. The subscriber name or date of birth is a mismatch. An account has incorrect insurance coded for third-party liability.
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In preparation for the Recovery Audit Contractors (RACs) and to improve patient flow, Durham Regional Hospital redesigned its case management department and moved to a triad model of patient care.
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By redesigning its case management program and beefing up technology, Saint Thomas Health Services reduced the average length of stay systemwide by 0.20 days and saved more than $6 million in just two years.
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In an effort to ensure that the patients most vulnerable for readmission stay safe at home after discharge, Lutheran Medical Center is developing a pilot program with a local home care agency to provide at least one home care visit for the majority of congestive heart failure patients going home with no services.
