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Tools for Closing the Case

October 22, 2007
by Steve Blau
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Case management systems can help reduce length of stay while offering continued care.

In 1970, a patient admitted to a hospital expected an average length of stay (LOS) of 7.8 days, according to the Centers for Disease Control. Since then, a number of advances in medicine and outpatient care have had a large effect on LOS, causing it to decrease through the years to 4.8 days in 2004. In addition to advances in medicine and care, new healthcare technologies have greatly helped reduce LOS in our nation's hospitals, cutting back on costs and improving the quality of care received.

Case management systems have reduced LOS by improving communications between a patient's care team, streamlining processes that prohibit a patient from being discharged, and preparing patients to receive continued care in their home.

In 2000, the administrative team at Good Samaritan Hospital in Baltimore, Md. decided to implement a case management system. We had three goals in our implementation of a case management system — reduce average LOS, improve overall efficiency within hospital departments, and continue to provide the best quality care for our patients.

We chose Allscripts Canopy, a case management system that automates utilization, discharge and quality management processes relating to patient hospital visits. We immediately noticed an improvement in our operations in the months following implementation. Implementation of a case management system creates open communication, ensures efficient care with guided discharges, and helps to prepare patients who require continued care after their hospital stay.

Open communication

In the years before case management systems, our medical teams depended on the case manager to verbally communicate to everyone regarding updates on patient needs, improvements and discharge status. With a case management system, this information is available electronically to all members of the patient's team — including physicians, nurses, ancillary departments and social workers. Information is available for call up instantly throughout the hospital.

Efficient care and guided discharge

Patients often experience extended stays at hospitals because inefficient communication prevents them from meeting criteria for discharge. However, a case management system flags patient needs and sends them out to all members of the care team, allowing the team to respond efficiently to imminent needs that could expedite discharge. As a result of shorter LOS, patients and hospitals find they do not have as many problems fighting insurance companies concerning denied days.

Continued home care

Case managers and social workers are an integral party of a patients care team. With the support of a case management system, case managers and social workers can help patients prepare for the continued care they may need outside of the hospital. Preparing a patient for continued care at home greatly reduces LOS for that patient. This feature is especially important for older patients and patients who may benefit from hospice services.

A case management system aids case managers in organizing home staffing for a patient, and equipping the house with necessary medical supplies and equipment. Patients are often pleased with this feature, as they would prefer be in the comforts of their own home for continued care, rather than in a hospital.

Needless to say, Good Samaritan Hospital has benefited greatly from the implementation of a case management system. As far as numbers are concerned, in the first six months of implementation, Good Samaritan experienced a LOS reduction of 40 percent from identification of "not meeting continued stay criteria" to the time of discharge, within the first six months. Within 12 months, the percentage of patients discharged within (one) day after it had been determined they did not meet acute care criteria increased from 61.9 percent to 92.

We now feel confident that we can provide quality, efficient care to our patients as our hospital continues to grow and see more patients at an exponential rate. Case management systems have helped us free more beds to serve more patients each year. In addition, hospital employees are satisfied with the case management system because open communication has helped to streamline workflow and reduce unnecessary stress. But most importantly, patients are more satisfied with the care they are receiving because a case management system ensures quality, efficient care that will help them return home healthy, quicker.

Steve Blau is director of case management at Good Samaritan Hospital, Baltimore.