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A hospital in Fargo, ND, focused on preventable falls in its cardiac telemetry unit and is seeing admirable results. After a year of effort, falls were reduced by 25% at the end of 2012, and then the hospital hit a 50% reduction barely a month later.
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After New York Presbyterian Hospital developed barrier reduction teams on each service to determine reasons for delays in the discharge process and come up with solutions, the average length-of-stay hospitalwide dropped by half a day and patient satisfaction scores increased.
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Faced with the closing of the state psychiatric hospital in their community, hospitals, law enforcement, mental health providers, and community agencies in Raleigh, NC, began collaborating on improving care and transitions for the mentally ill.
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At Duke Raleigh Hospital, case managers in the emergency department lead interdisciplinary behavioral health rounds each day on all patients with psychiatric signs and symptoms.
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Every hospital has patients it sees over and over, often for preventable conditions or problems that could be treated in a lower level of care. According to the Agency for Healthcare Research and Quality, the top 1% of healthcare users account for 21.4% of healthcare expenditures. In this issue of Hospital Case Management, we'll show you what case managers are doing to help patients avoid unnecessary hospital visits and to seek treatment in an appropriate level of care. You'll learn how one hospital's "red carpet treatment" has cut hospital visits among super utilizers, how embedded case managers target high utilizers, and how dealing with social issues helps keep patients out of the hospital. We'll describe a community approach to mental health transitions and a program to help emergency department patients navigate the health system.
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MetroHealth Medical Center in Cleveland has partnered with two health plans to provide intensive care coordination for high-cost patients with multiple medical problems and, often, behavioral health issues.
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Care managers embedded in primary care clinics work with patients with high-risk diagnoses and multiple visits to the emergency department or hospital.
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Carondelet Health Network in Tucson, AZ, places community health outreach workers in the emergency department to help patients who use the ED for non-emergent conditions find a primary care provider.
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At the University of Michigan Health System, complex case managers coordinate inpatient and outpatient treatment and psychosocial services for patients who frequently visit the emergency department or are hospitalized.
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Because the needs of the senior population are different from the needs of younger patients, hospitals should make changes to create an emergency department geared to the needs of seniors, says William Thomas, MD, an elder care expert who is working with Livonia, MI-based Trinity Health on geriatric issues and development of the senior emergency departments.
