Your role in JCAHO's continuity requirements
Continuity to receive more attention in 1998
By Patrice Spath, ART, BA
Consultant in Health Care Quality and Resource Management
Forest Grove, OR
Continuity of care is more than "transfer agreements." The ultimate test for any organization will be its ability to integrate information systems and caregiver communication to deliver seamless, cost-effective quality health care. The Joint Commission’s Continuum of Care standard for hospitals emphasizes that hospitalizations should be viewed as part of a continuum. According to the standards, hospitals must define, organize, and sequence processes and activities to maximize the coordination of patient care. This function is divided into five different components: activities before admission, during admission, while the patient is hospitalized, before discharge, and at discharge.
Case managers play an important role in meeting the Joint Commission’s Continuum of Care standards. They must understand the integrated system of processes that make up the continuum of care throughout the organization and help to ensure that the mechanisms established to maintain continuity of care are upheld as patients enter or leave the hospital. Case managers should be involved in the development of policies regarding patients’ access to appropriate care and criteria used by each department or unit to determine the appropriateness of a patient’s entry to that setting or service.
An important responsibility of case managers is to assist physicians and staff in assuring continuity of care when they are receiving patients or sending them to another area of the hospital. The JCAHO standards require that patients are provided with pertinent information as they move through the organization and care is coordinated with other health care professionals. Joint Commission surveyors will be reviewing open medical records and evaluating documentation to determine whether adequate information has been shared among caregivers as the patient transfers to different levels of care.
A "continuum of care interview" is held during the survey. The purpose of this interview is to assess how the organization plans and provides for continuity of care. Participants in this interview include representatives from administration, medical staff, nursing, social work, utilization review, discharge planning/case management, emergency services, special care units, ambulatory/outpatient care, home care/hospice, and long-term care. The case manager and other participants in this interview should be prepared to answer the following questions:
• What criteria does your organization use to determine the appropriateness of a patient’s entry to your facility and to individual services?
• Upon a patient’s entry or admission, what mechanisms are in place to provide patients and families with information about the care they are going to receive?
• What procedures have been instituted to ensure continuity of care for patients as they move to different areas in the organization?
• What mechanisms are in place for coordinating patient care among health care professionals?
In addition to this interview, continuum of care issues are assessed during document review, medical record review, visits to patient care settings, and at various leadership interviews. Documents that may be reviewed by Joint Commission surveyors include:
• policies or criteria departments use to determine that a patient is appropriate to receive the care/treatment provided in that department or service;
• policies, procedures or other documentation outlining the process for referral, transfer, or discharge of patients to another level of care, health professional or setting.
During their visit to the patient care unit, surveyors will assess continuity of care issues by asking questions of the staff. These questions may include:
• What is your role in discharge planning?
• How do you obtain patient care and clinical information when patients are being admitted, referred, transferred, or discharged to your service area?
• What mechanisms are in place to assure that you provide adequate patient care and clinical information to other settings when you are referring, transferring, or discharging a patient?
Case managers can help ensure that staff are able to answer these questions by providing ongoing education to unit caregivers during patient rounds.
1998 survey hot spots
Continuity of care issues will receive even more attention from the Joint Commission in 1998. Case managers should be involved in the development of criteria and processes to meet the intent of the standards. Several of the "hot spots" are listed below:
• The standards state that patients should have access to the appropriate type of care (CC.1). Criteria to determine appropriate care settings or services should be developed to explicitly state which patients are appropriate to admit to your hospital. Criteria also should be developed to determine where a patient is placed in your organization, especially for the areas of critical care, rehabilitation services, subacute, mental health, and pediatrics (CC.2.1). Examples of criteria for patients with syncope are shown on p. 223.
• If patients present to your hospital for services you do not provide (such as psychiatric services or pediatric care), the organization must have a plan in place that addresses how these patients will be handled. This plan should include a description of the formal affiliations or informal agreements you have with other facilities where these patients can be transferred or referred, and the criteria used to make transfer/referral decisions.
• At the time of entry into the hospital, patients and families should receive information about the costs of care. This information may relate to their expected copayment or deductible, or their personal financial obligation to the hospital (CC.3). It’s important for the facility to have a defined process for sharing this information, and a mechanism for documenting compliance with the process.
• Define how caregivers will address patient needs that were identified but could not be met due to a short inpatient stay (CC.6.1). For example, if you identify that a patient needs a nutritional assessment based on the screening criteria you have developed, and the patient is discharged prior to the patient receiving the assessment, identify how you will communicate this patient need to the individual(s) who will be responsible for the patient’s ongoing care needs, i.e., primary physician, home care nurse, or nursing home.
• Define the mechanisms for communicating information when patients are transferred between acute care units and other components of your continuum of care. Patient care reporting between units and components should include physiological, psychological, and social information (CC.5, CC.7).
The Joint Commission’s Continuity of Care Standard is designed to ensure that timely and relevant information is communicated within the delivery system to support continuity of care. Case managers can help ensure that appropriate information is communicated to any care and service provider organization or practitioner office to which the patient is admitted, referred, transferred, or discharged. The type of patient-specific information that should be communicated among care providers includes:
• the reason for patient transfer, referral, or discharge;
• relevant physical/psychosocial status information about the patient at the time of transfer, referral, or discharge;
• a summary of the care or service provided to the patient and their progress toward achieving goals;
• instructions and names of referrals given to the patient.
Ideally, any care provider within the health care delivery system should have ready access to needed information about all previous care given to a patient anywhere throughout the system. This information should be provided in a timely manner by hard copy or computer screen display. Many organizations are working toward developing a computer network linking all providers’ sites. The Joint Commission does not require health care organizations to develop computerized information systems; however, most organizations are moving in this direction to enhance their managed care positions. Case managers should be involved with the information system task force in their organization to help design meaningful information linkages between health care facilities that will enhance continuity of care.
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