Hospital case management : the monthly update on hospital-based care planning and critical paths
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Sycamore Medical Center's Lean project to improve patient flow in the emergency department resulted in an increase in patient satisfaction scores and a decrease in patients who left without being seen. A multidisciplinary team analyzed how patients arrive, how they are treated, and how they are triaged. The team examined the work of all emergency department staff and made changes to optimize their time. The team created a set of essential care orders the hospital can use if the patient is stable and can go to the floor.
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Two-thirds of hospitals in the United States are losing reimbursement on each Medicare discharge as a result of their performance on the Centers for Medicare & Medicaid readmission reduction program--and the penalties and diagnoses included will only escalate. Hospitals and case managers have to make a paradigm change and focus not only on moving patients through the continuum but keeping them from returning to the hospital, some experts say. Reach out to post-acute providers and make sure that they have the information they need to care for patients at the next level of care and that patients aren't receiving follow-up calls from multiple sources. Analyze all readmissions to determine why patients came back and take steps to improve your processes.
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Bassett Medical Center's readmission project cut 30-day readmissions by up to 70% for the highest-risk patients and resulted in the medical center being one of only 20 hospitals in New York State that did not incur readmission penalties from the Centers for Medicare & Medicaid Services. The care coordination team includes case managers, social workers, and patient service coordinators who set up post-acute services and call at-risk patients within a day of their discharge. Case managers round with physicians and refer patients who have psychosocial needs to the social workers for follow up. Continuing care coordinators at primary care offices attend multidisciplinary rounds with the hospital team and receive detailed information about the hospital stay.