By Melinda Young
Health systems that work to improve social determinants of health, including transportation, may find their actions improve patient care and follow-up, discharge, and throughput efficiency.
For example, UCSF Health found case managers could more easily plan discharges and turn over beds once they solved the issue of finding rides home for clients without family or social support.
The transitions team and other hospital staff can schedule transportation for patients upon discharge, says Molly Shane, MS, BSN, RN, executive director of care management and patient transitions at UCSF Health.
Before creating the transportation program and scheduling platform, case managers had to arrange each patient’s transportation separately, wasting time in trying to find available drivers. Plus, the cost of the rides was inconsistent.
The transportation program offers price transparency, standard pricing, and consolidated billing. The health system receives one bill a month instead of 40-plus bills a month. Also, there is more time to plan and see how transportation services are used.
“We can have days planned out for when we need transports,” Shane says. “It’s done online, like ordering Lyft or Uber.”
The staff member enters the patient’s destination and time of discharge, as well as the level of care needed. The platform indicates which subcontracted vendors are available.
“It’s this patient who needs to go to this location at this level of care, and they say they’ll take it,” Shane says. “We have confirmation that the ride would happen as requested.”
The transition team estimates the patient’s discharge time, scheduling the ride as far in advance as possible. “If we need something right away, we can work with the concierge team and get [a ride] very quickly,” Shane explains.
This allows case managers and discharge planners to assess capacity and through-time efforts. “We used some tools within our electronic medical record to make discharge predictions,” Shane notes. “We use estimated discharge data as an indicator of who will leave the hospital on any particular day.”
With the data, staff arrange patients’ discharge as soon as possible. “We can book transportation ahead of time, so we make sure we have that arranged and are able to get people out as soon as possible,” Shane explains. “Having the ability and ease to do that quickly has allowed us to identify peak time and work together to see if there are any opportunities to shift [patients] earlier and make sure we’re not clogging the system.”
For instance, the transportation program’s data determined which time frames were the busiest for discharges. Case managers informed the transportation contractors of these periods, which were when they would need access to the most vans.
This information also convinced the discharge team to make changes and start discharging more patients in the morning, which typically was slower. These actions helped improve discharge efficiency.
The online scheduling is a huge time-saver. Before the program, it took 40 minutes to schedule one transport. Now, it takes about a minute. This efficiency saves staff time and administrative burden.
“It saved 98 hours a month of time for patient transitions staff, who sometimes are discharge planners and case managers, and sometimes are discharge coordinators,” Shane says. “They gained time in their day to accomplish other tasks that are not as time-consuming.”
The program also improved efficiency for the entire hospital. “Shifting the peak time of when people utilize this resource for leaving the hospital has an impact on our ability to decompress our hospital system,” Shane explains. “We often have an overflowing ED that is holding patients. The sooner we can discharge them from hospital beds, the sooner we can get ED people into a new bed.”
Case managers have one less worry when timing a patient’s discharge. The transportation program is a big plus in creating overall efficiencies.
Another tactic for scheduling rides is to assign the hospital’s transportation department, says Kristin O’Neal, BSN, RN, ACM-RN, CCM, a former transitions of care administrator for a large health system in Norman, OK.
Ideally, the drivers are compassionate, thorough, and flexible, particularly when they are driving patients to post-discharge medical appointments.
“Many times, the appointments would run long, and [the patient] would call here and tell me they’re still here, waiting to have their dressing changed, but the driver is already here,” O’Neal explains. “I’d call the driver and say, ‘Can you wait 10 more minutes?’”
Drivers should understand their priority is to attend to patient’s needs and to be flexible when a patient’s appointment takes longer than planned. “They have to be flexible and be able to think quickly and process why they need to wait and how important it is,” O’Neal says.
Health systems that offer transportation programs benefit overall, even though there are some infrastructure and logistical issues to overcome. This includes finding drivers who understand it is not the same as Uber when it comes to quickly picking up and quickly dropping off people.
But the benefits to patients, providers, and the health system may prove worth the effort. This happened when discharge staff saved time in care transitions.
“Anywhere we can create efficiencies to allow clinicians to work at the top of their license is our overall arching goal,” Shane says. “We were spending so much time on non-value-added resources and workflow to achieve one thing. Anything we can take off [discharge planners’] plates is definitely a value added.”
Health systems that work to improve social determinants of health, including transportation, may find their actions improve patient care and follow-up, discharge, and throughput efficiency. For example, UCSF Health found case managers could more easily plan discharges and turn over beds once they solved the issue of finding rides home for clients without family or social support.
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