Critical Path Network
Wireless laptops improve CMs' efficiency, cut LOS
Documentation is completed in patients' rooms
Wireless laptops at Montefiore Medical Center in New York City have dramatically increased the efficiency and effectiveness of the case managers, improved throughput, and enabled them to monitor patients who are readmitted frequently.
The hospital's 10 nurse case managers began using their wireless laptops, connected to the hospital's district server in December 2005, according to Alex Alvarez, RN, BSN, director of the care management resource unit at the two-hospital medical center. The nurse case managers are employed by the Network Management Service Organization.
The hospital has had universal work stations equipped with computers on every unit for years.
"The problem has been that the computers are always in use and there simply was no place to put extra computers. By using laptops, the case managers can access the hospital's server from anywhere. They do more because they're much more efficient," he says.
Having a laptop they can take with them into patients' rooms minimizes the time the case managers spend in the office and gets them out on the floor, working with patients and the treatment team, Alvarez says.
The case managers, who are assigned by unit, received new laptop tablet-type computers in December 2005. Earlier in the year, the hospital deployed an electronic patient folder (EPF) that makes previous medical records available on the hospitals' computer system.
The combination of the laptops, access to the hospital's clinical information system, and the EPF saves the case managers time in organizing their day, gives them constant access to their patients' medical records and past medical history, allows them to track the patient's progress, and monitor laboratory and other procedures in real-time. They can take the laptops into the patient rooms and document while they are talking to the patients, rather than relying on their notes and entering the information later.
When a patient is discharged from Montefiore Medical Center, his or her chart is scanned into the hospital's computer system within 48 hours.
This allows the case managers to research a patient's chart and get notes on his or her last admission.
"The case managers now have full access to the previous medical record. In the past, they had to go to the medical records department, request a chart, and wait a day or two to get it," he says.
When the case managers log on to the computer, they have a list of new admissions from the day before, divided by unit. The hospital's clerical support staff identify patients who meet the criteria for review and place them on each case manager's electronic work list. The wireless laptops have allowed the case management department to initiate a project to reduce frequent readmissions by drilling down to determine the reason for the readmissions.
Each day, the hospital's admission system identified all admissions from the previous day that meet the criteria for multiple admissions. Those patients are flagged as they are assigned to case managers.
Using the electronic medical records system, the case managers review the previous admissions to look for the reason the patient was readmitted and then interview the patient and family members and talk to the admitting physician, in an effort to identify why the patient is readmitted frequently.
"It may be that the patient can't pay for the medications they need, lack of knowledge about their condition, missing follow-up visits with the physician, social issues, or other problems," Alvarez says.
The case managers contact the primary care physicians to find out what has been going on with the patients and to find out whether the physician knew that tje patient had been admitted to the hospital.
They discuss the discharge plan with the primary care physician and work with him or her on strategies to prevent readmissions.
The case managers and the utilization management staff can use the laptops to make referrals to skilled nursing facilities directly from the patient's hospital room, often getting a response while they still are with the patient and family.
"It saves a lot of time on the telephone and gives the case managers more time to spend with their patients," Alvarez says.
The network care management department, made up of case managers and utilization management nurses, uses an electronic discharge planning system that allows case managers to create referrals and send them automatically to participating skilled nursing facilities.
"Using this system allows us to give the patients a choice of facilities, and, with one keystroke, we can send a referral to numerous facilities and get a response on-line, sometimes within minutes," Alvarez says.
The system allows the hospital to leverage the competitive skilled nursing home market, Alvarez added.
"The nursing homes in our area are looking for a way to be ahead of the competition, and they respond very quickly. It's really helped us on throughput issues," he says.
The hospital began using the electronic post- discharge placement system in July 2004. In 2003, the average length of stay for patients being discharged to a skilled nursing facility was 10.01 days.
"This system was slowly deployed and made available to the entire hospital in December of 2005. On the units where the system had been deployed, length of stay was down to 8.5," Alvarez says.
Alvarez attributes the drop in length of stay to the efficiencies of the electronic post-acute referral system, which allows case managers to make numerous referrals at the same time, and the medical center's computerized clinical information system, which allows case managers to monitor patients' progress and ensure that they are referred to a skilled nursing facility in a timely manner.
For more information, contact Alex Alvarez, RN, BSN, director of the care management resource unit at Montefiore Medical Center, New York City. E-mail: [email protected].
Wireless laptops at Montefiore Medical Center in New York City have dramatically increased the efficiency and effectiveness of the case managers, improved throughput, and enabled them to monitor patients who are readmitted frequently.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content