Critcal Path Network
Central admissions process improves patient care
Nurses manage the admission of all patients
At Central DuPage Hospital, a dedicated team of nurses, called patient admission coordinators, manage the admission of all patients.
This initiative, which began in July, is part of a comprehensive program to redesign the admissions process, the beginning point for patient flow and throughput, according to Lea Ann Arnold, BSN, manager of care coordination at the Winfield, IL, hospital.
The patient admission coordinators, who previously worked as utilization management nurses, staff the admissions office from 7 a.m. to 11:30 p.m. seven days a week and are the initial contact for all admissions coming into the hospital.
"It's like a centralized clearing house. Every admission goes through them," Arnold says.
The patient admission coordinators are able to take faxed or verbal admission orders from physicians and to accept clinical information from outpatient areas such as the cardiology lab and the emergency department.
"The patient admission coordinators are able to discuss signs and symptoms with the physician or the physician office nurse, determine the plan of care, and obtain a clinical picture of patients, which will help them determine the appropriate venue of care, appropriate admission status, and the unit where the patient will be admitted," she says.
The patient admission coordinators encourage the use of pre-printed order sets the hospital developed to promote compliance with the core measures and best practice guidelines.
"The core measures and best practice guidelines are embedded in the order sets. They have built-in ticklers, such as three options for simple, complex, or aspiration pneumonia and options of antibiotics recommended as best practices," Arnold adds.
When a doctor's office calls to admit a patient, the patient admission coordinator offers to fax a copy of the preprinted order set. The physician can fill it out, sign it, and fax it back.
"In just a few months, we have gotten good response from the admitting physicians. They know that they can call and talk to a nurse who can understand the clinical picture of the patients and get them to the appropriate level of care," she says.
The initiative also aims to improve patient registration and clarify information on the notice of admit that is given to the insurance companies.
"The patient admission coordinators have a conversation with the registrar prior to admission to clarify the clinical picture and the reason for admit. Because the nurses are clinicians, they have better knowledge than the registrars about the admission status and diagnosis. Having the nurse involved in developing the notice of admission gives us more accurate information for the insurance company," she says.
Before the initiative began, patients were placed in beds through a variety of admission ports of entry, Arnold says.
The house supervisors placed patients from the emergency department, patients who were direct admissions, and patients admitted for unscheduled stays after outpatient procedures.
The centralized scheduling office, staffed by registration personnel, placed patients for medical admissions scheduled for the future and for specific procedures that were done on the nursing unit.
The old system was frustrating for the utilization management nurses because patients already were in a bed by the time they saw them and they were not always placed in the right admission status, Arnold says.
As part of the redesigned admissions process, the hospital is in the process of implementing a new electronic bed board system.
The system will allow the admission nurses to work hand-in-hand with transportation and housekeeping and to be aware in real time when beds become available, Arnold says.
When the patient is ready to be discharged and transportation is called, the system will alert housekeeping to start cleaning the room. The housekeepers will log in when they get to the room and have a target of being finished in 20 to 30 minutes.
"The admissions nurses will have a bed tracking tool that allows them to see what patients are in what room, when they got there, and their disposition," she says.
Currently, the hospital has a bed board meeting at 9 a.m. seven days a week, during which the charge nurses from all units discuss the bed status and patient status on the unit with the patient admission coordinators.
"We look at which patients are scheduled to be discharged, what discharges are anticipated, what barriers there are to getting a patient discharged, and how we can work to overcome the barriers," Arnold says.
Additional meetings to discuss patient status and bed status are held at 4:30 p.m. and 4 a.m.
The electronic bed board will streamline the process and eliminate telephone calls between the admission coordinators and the units to find out if beds are available, she says.
The next phase of the redesign project is to have the initial clinical reviews performed by the admission nurse on the day of admission. The initiative will provide information to the care coordinators on the unit as soon as the patient is admitted.
The hospital is moving toward a documentation system for the care coordination team that starts with registration and admission, captures financial and pay information, and includes modules for discharge planning, medical necessity review, delayed days, and denials management.
"This is a work in progress. We're working synergistically to improve patient flow and the patient experience," Arnold says.
[For more information, contact Lea Ann Arnold, BSN, manager of care coordination, Central DuPage Hospital, [email protected]]
At Central DuPage Hospital, a dedicated team of nurses, called patient admission coordinators, manage the admission of all patients.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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