Redesign standardizes care coordination
Unit staffers spend more time with patients
A far-reaching redesign of the care coordination process at Norfolk, VA-based Sentara Healthcare has standardized the process across hospitals, centralized the administrative and clerical tasks that care coordinators must perform, and freed the staff at the bedside to concentrate on working with patients.
The redesign, which took about a year, has resulted in enhanced staff satisfaction and anecdotal evidence that it has reduced length of stay, but it's too early to have any firm data, reports Teresa Gonzalvo, RN, BSN, MPA, CPHQ, ACM, vice president for care coordination. Gonzalvo is responsible for care coordination at Sentara hospitals, including Sentara Norfolk General Hospital, the system's flagship hospital, in Norfolk, VA.
"Our vision at Sentara is to be a leader in facilitating case management across the continuum and providing patient-centered, high-quality care, but to do so we need to make sure every care coordination department is doing the same thing consistently," Gonzalvo says. "There was a lot of variation in the care coordination process when we began."
Phase I of the redesign involves seven hospitals, all in southeastern Virginia, that have been using Sentara's electronic medical record for a few years. Three other hospitals, in northern Virginia and the Blue Ridge region, will be part of Phase II after they also implement the electronic medical record system. "We want to maximize technology as a way of creating efficiency," Gonzalvo says.
A key component of the redesign was to create a centralized Resource Management Center with staff to handle the administrative and clerical tasks involved in care management for all the hospitals, which freed the care managers on the unit to spend more time with patients. (For details on the Resource Management Center and how it operates, see related article, below.)
The redesign created teams of unit-based RN case manager care coordinators and master's-prepared social workers who collaborate on care coordination and discharge planning. In some hospitals, LPNs were a part of the care coordination team and continue to work as associate care coordinators in those hospitals. "We wanted to incorporate all the expertise of our existing staff while developing a unified model for our individual hospitals to use," Gonzalvo says.
Depending on the size of the hospital and the size of the unit, some care coordinator/social worker teams cover more than one unit. "Now that we have removed all the administrative and clerical duties, the care coordinators and social workers are expected to be on the unit, talking to physicians, patients, and family members and facilitating communication," she says.
Frequent communication is a key component of the redesigned care coordination program. The RN care coordinator and social worker on each unit have a daily huddle to discuss priorities and what is needed for the patients who are slated for discharge. The multidisciplinary teams in each unit have regular rounds to talk about the patients and update the plan for the day and the plan for the stay, Gonzalvo says.
At least once a week, the entire care coordination staff, the director of finance, and the vice president for medical affairs at each hospital hold care progression rounds to discuss long-stay patients and those with complex needs. The manager of care coordination identifies cases to discuss and invites other disciplines, such as wound care, hospice, or palliative care if appropriate. "Without everyone on the team rounding and being in constant communication, we couldn't be successful," Gonzalvo says.
Sentara Healthcare is rolling out a program in which care coordinators review patient records for medical necessity and admissions status when they come through the emergency department, the post-anesthesia care unit (PACU), the cardiac catheterization lab, and the obstetrics unit. "One thing we know really works is having care coordinators monitoring all points of entry for patients," Gonzalvo says.
In May, the clerical staff began setting up follow-up appointments with primary care providers, prior to patient discharge, to make sure there is a seamless hand-off between levels of care. "We are working to maximize the tools and workflows we have in place to meet our care coordination goals and to prevent unnecessary admissions and readmissions," Gonzalvo says
Before the redesign, each hospital's vice president of medical affairs assisted with the secondary reviews for admission criteria and patient status. Because of the sheer volume of reviews, some were not handled in a timely manner. Now the health system has contracted with an off-site physician advisor to perform the admission criteria reviews. The vice president of medical affairs continues to act as an advisor for continued stay reviews and commercial payer reviews.
The contracted physician advisor organization has conducted a comprehensive education program in documentation and admissions criteria for the medical staff, care coordination staff, and other appropriate staff. Sentara also has contracted with a consultant for an ongoing review of the effectiveness of the process.
The care coordination department is working with the information technology department to identify case management software that will interface with the hospital's system software as well as the technology being used by Medicare and Medicaid auditors. "We are working on a number of projects to meet the challenges of the future as well as the challenges of today," Gonzalvo says. "We need to be able to get patients the treatment in the right setting and move them through the care continuum in a timely manner. We believe that level of care coordination will ultimately improve patient outcomes."
Source
For more information contact:
- Teresa Gonzalvo, RN, BSN, MPA, CPHQ, ACM, Vice President for Care Coordination, Sentara Healthcare, Norfolk, VA. Email: [email protected].
Resource center supports CMs at 7 hospitals Unit staff free for patient care Sentara Health's Resource Management Center is staffed by 26 RNs, LPNs, and clerical staff members who support the care coordinators at seven hospitals, all in the Norfolk, VA, area. "The main purpose of redesigning the care coordination process is to provide patient-centered care," says Teresa Gonzalvo, RN, BSN, MPA, CPHQ, ACM, vice president for care coordination at the Norfolk-based healthcare system. "This has been fostered by removing the administrative and clerical work from the clinical staff at the bedside and centralizing it in a newly created location. The care coordinators are there to meet the needs of the patients and respond to whatever needs doing, rather than spending their time on the telephone or doing paperwork." The Resource Management Center (RMC) staff handles all utilization management, including admissions reviews, continuing stay reviews, and retrospective reviews of patients in all hospitals. They also facilitate discharges by arranging for equipment and other post-acute services and managing referrals for post-acute care for all seven hospitals. "When patients make their choices of post-acute providers, the RMC staff receives the information along with other key patient information," Gonzalvo says. "The RMC uses an electronic discharge planning system to send inquiries to those post-acute providers. This process is designed to decrease length of stay and increase patient satisfaction." A team of dedicated department auditors who monitor compliance issues and perform audits for all hospitals in the system perform quality reviews of the RMC on a regular basis. The Resource Management Center also manages a centralized pool of part-time and temporary healthcare professionals who can fill in for the regular staff when they are taking vacation time or sick leave. The healthcare system has created an array of dedicated positions in four categories for resource pool staff. Categories include staff members who want to work only at a particular hospital, staff members who want to work in one of two geographic zones, and staff members who will work at any of the hospitals or the RMC location. Each option has a different salary range, correlating with the flexibility required of the staff to go where they are needed. "Our aim is to attract seasoned professionals to our staff who want to work only a couple of days a week and to create a flexible system so they can work wherever they are most comfortable," Gonzalvo says. The staff members at the Resource Management Center previously worked in case management at one of the seven hospitals participating in the redesign program. Gonzalvo established the RMC positions and pay categories with the help of the human resources department, then asked the staff members who were interested in working there to sign up. "The staff at the RMC loves what they are doing, and we're seeing some really good results," she says. |
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