Great suggestions and I concur that planning for discharge to the degree possible, prior to patient admission has been of tremendous assistance in reducing our length of stay, particularly with pre-planning home health visits, post-discharge follow-up visits and discharge prescriptions. Many organizations also use a dry erase board in each patient’s room which identifies the plan for progression of care for the day with discharge goals identified and an anticipated discharge date assigned at the time of admission.
A novel concept that was in place in a previous market that I worked was for a staffing agency to provide a non-licensed, bonded, insured staff member to meet the patient at the time of hospital discharge, drive them home, and assist in ensuring they were set up in their home and perhaps assist with a meal preparation, pick-up medications from the pharmacy or run other short errands. A nominal fee was charged for this, which included the transportation and a maximum of two hours of assistance. This helped to alleviate the delays we often experienced with patients needing to wait for a ride to get home.
It might be helpful for the four individuals to whom this employee reports to ensure that the scope of work for this role is well defined, deliverables and timelines identified and a STRUCTURED communication plan developed and implemented that included the communication needs of the leaders for information. The employee needs to understand the impact of the communication style that they have deployed is not working for the organization, and be redirected towards expectations. If the structure was not put into place when they were onboarded to the organization and project, then now is the time to do so. Fit and skill and equally important, but I have always found better outcomes are derived when conflict occurs between the two to focus on fit, and train for skill.
Perhaps the concept of an Urgent Care Center, in which non-life threatening conditions could be treated, may be an option with greater resources provided to your triage function so that only the most appropriate patients are then transitioned to access emergency services. In other urban settings that I have worked, a barrier to access of primary care services was transportation, so for a convenience factor, families would drop patients off at the Emergency Department when primary care clinic was more appropriate. We developed a transportation system of shuttling patients to the primary care clinic in town, once it was determined that they were not experiencing a medical emergency. The intent was to have them established in a primary care clinic and derive the benefits of appropriate site of service care, and the longitudinal benefits of being plugged into a primary care model for disease management.
We have a telephone reminder service that calls individuals 48 hours prior to their appointments, but can be reset for any length of time desired. It is linked to our scheduling system to support the automatic calls being made. We also follow-up with every patient who is a “no show” within 24 hours of their visit to determine what contributed to their absence. In addition, we ask at registration of a new patient if there are potential barriers for them and we aid in coordinating support for them, which in our area, is usually transportation.
I agree that ensuring consistency of procedural guidelines is essential. To that end, we identified a clinical nurse leader to provide oversight of the manner in which sedation was being performed in our procedural areas with the most significant activities occurring in our interventional radiology department. Workflows were reviewed, documentation tools revised, universal protocol reviewed to ensure consistency with the peri-operative processes. We were just recently reviewed by the Joint Commission who viewed every area in which conscious sedation was provided, and they were please with our processes. It took an individual with the requisite authority, working with Department Chairman to impact the changes that were necessary.
Our GYN Oncology program has established a protocol that has now been implemented throughout our GYN surgery service which significantly reduces the amount of opioids that are prescribed post-operatively. It has been well -received by patients with greater than 90% of patients acknowledging that their post-op pain is being controlled, and satisfaction among patients with their post-operative management. We will soon be expanding the protocol into other surgical services. Manuscript preparation in now in process so that we may begin to share the details with others. I’ll make sure to provide you with that link as it becomes available.