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As hospitals experience an increasing number of audits for medical necessity of admission, it's more important than ever to make sure that patients are in the appropriate status and that the medical record contains the documentation to support the status, says Deborah Hale, CCS, president and CEO of Administrative Consultant Services LLC, a health care consulting firm based in Shawnee, OK.
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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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As IRBs review the rollout of new biobanks, they need to ensure that people who agree to participate in them truly understand what that means.
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Tracy Arwood, MS, director of research compliance at Clemson University's office of research compliance in Clemson, SC, has dealt with a variety of consent issues over the years, including handling informed consent of college students and from community leaders. She offers this advice about how to improve the informed consent process to IRB Advisor readers:
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As IRBs face budget cuts, they can make some improvements in their processes that will make them more cost efficient.
