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When Brookhaven Memorial Hospital Medical Center redesigned its case management function, merging the social work, utilization review, and clinical guidelines departments, the hospital cross-trained staff in all three departments to handle case management functions.
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A patient's chart is unavailable. Verbal orders are not yet written in the patient's chart. The identification bracelet is not yet on your patient. These are three reasons that an ED nurse may fail to comply with one of The Joint Commission's National Patient Safety Goals (NPSGs): the requirement for use of at least two patient identifiers.
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By implementing a Lean process change that it calls TAPP (Team Assessment Pull Process), the ED leadership in the Children's Healthcare of Atlanta system has realized a 25-minute reduction in median overall turnaround time, from 192 minutes to 167 minutes, excluding its fast track.
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No ED cuts its average door-to-doc time from 93 minutes to 20 minutes by accident. The success story at Memorial Hermann Memorial City Medical Center in Houston was the result of discovering a patient flow model at another facility that was superior to theirs, and then continuing to search out additional models to come up with their own system that best addressed their specific needs.
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Before a patient at Christus St. Vincent Regional Medical Center is registered or assigned to a room, a utilization review nurse in the hospital's Patient Intake Center reviews the patient's clinical information and collaborate with the admitting physician to determine that patient's status.
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According to the Centers for Medicare & Medicaid Services (CMS), observation services are "a well-defined set of specific clinically appropriate services, which include ongoing short-term treatment, assessment, and reassessment."
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There is a significant amount of research that demonstrates ED crowding due to boarding is responsible for poor outcomes, says Tom Scaletta, MD, president of Emergency Excellence, a Chicago-based organization that improves patient care and efficiency in the ED while controlling costs. He also is medical director of a high-volume community hospital in a Chicago suburb.
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Although a recent study at the University of Rochester (NY) seems to indicate that telemedicine could eliminate many pediatric ED visits, a pediatric ED physician with extensive experience with telemedicine believes that its applications are not broad enough to have a significant impact on ED overcrowding.
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Telemedicine has long been recognized for improving access to care as well as access to specialist expertise, particularly in rural facilities.
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In its second year, the clinical documentation program at Jupiter (FL) Medical Center was able to increase DRG reimbursement by 75% over the previous year.
