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Before developing a protocol that delegates authority for determining patient status to case managers, a multidisciplinary team at Good Samaritan Hospital in Dayton, OH, spent several months researching the process, seeking advice from the Florida Quality Improvement Organization (QIO) and hospitals in Florida that had piloted a case management admission status protocol.
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The emergency department at Middle Tennessee Medical Center (MTMC) in Murfreesboro certainly qualifies as busy: It sees nearly 63,000 patients a year and averages more than 170 patients a day. Yet the average time it takes a patient to get to triage from entry into the ED is 14-17 minutes, and its door-to-doc time averages 35-40 minutes.
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In announcing its final rule for the Hospital Outpatient Prospective Payment System (OPPS) for calendar year 2009, the Centers for Medicare & Medicaid Services (CMS) reiterated its intention to strengthen the tie between quality of care furnished to people in hospital outpatient departments and the payments hospitals receive for those services.
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Discharge planning for orthopedic surgery patients at one major hospital begins well in advance of patients being admitted for surgery.
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Case management salaries are on the rise, but the vast majority of case managers are working far more than the typical 40-hour week, according to the 2008 Hospital Case Management salary survey.
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Sometimes the best response to regulatory and payer changes in health care is to improve the discharge planning process.
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When hospitals rely on a patient's family members to interpret medical news, they might be placing the patient at risk, an expert says.
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"Throughout our health care system, VA patients and staff face difficult and potentially life-altering decisions every day whether it be in clinics, in cubicles, or in council meetings. In the day-to-day business of health care, uncertainty or conflicts about values that is, ethical concerns inevitably arise." IntegratedEthics: Improving Ethics Quality in Health Care (U.S. Department of Veterans Affairs monograph)
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The IntegratedEthics program developed by the Department of Veterans Affairs (VA) for its facilities, which comprise the largest health care system in the United States, has drawn interest and attention both domestically and internationally.
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Even with the driven culture of modern medicine, one study published recently in the Journal of Medical Ethics found that 73% of 338 respondents said that they usually discuss their mistakes with their colleagues.
