Published by: Darlene Ebert on 1/18/2011 12:02:20 PM
It’s a problem that safety net hospitals across the country face: how to help the patients who need to be moved to the next level of care, but have become “stuck” in the hospital. Denver Health has found a way to help these patients reach the right level of care at the right time through a unique group – the Complex Discharge Committee. At the same time, the committee has helped to reduce the hospital’s average length of stay by a full day, over the last two years.
The Complex Discharge Committee was formed in response to numerous cases of complicated patients for whom safe discharges were difficult to achieve. The committee includes the Chief Medical Officer, Chief Operating Officer, Chief Financial Officer, General Counsel, Chief Government Relations Officer, Chief Nursing Officer, Director of Utilization Management, Director of Clinical Social Work, Director of Behavioral Health, and the Collections Attorney who work collaboratively with this special population.
The committee gathers weekly to review the list of inpatients who have complex issues that are delaying discharge.
Each case is reviewed and decisions are made on how to proceed in accessing the resources needed to move the patient to the next level of care. This may include an additional review of the patient’s medications; weaning the patient off of a ventilator; working with the transferring hospital to transport the patient back to his/her medical home; or working out arrangements with long term care facilities to provide transition care for patients whose Medicaid eligibility is pending.
The committee’s goal is to free up precious bed space in the hospital while ensuring that the patient receives the right level of care.
The General Counsel weighs in on cases where the courts or other legal proceedings come into play, and the Chief Governmental Relations Officer contacts foreign consulates to resolve issues pertaining to the patient’s country of origin.
On several occasions, the Director of Behavioral Health has intervened to determine whether a patient is competent to make decisions about his/her care or placement. When a patient is not competent to make decisions, and no next-of-kin can be located, the committee calls on community partners to assist in providing a solution or finding a guardian.
It’s all about being creative and finding ways to help the patient. The committee worked with the Denver Probate Court that hears guardianship cases to install a video conferencing system, at the hospital’s expense, that connects the court room to a hospital room so that frail patients do not have to be moved to the court for a hearing.
Also, the committee worked to hire a Nurse Practitioner (NP) to go to long term behavioral health facilities to assist care providers in monitoring and maintaining medication regimes in order to sustain a patient’s placement.
Utilization Management and Clinical Social Work committee members now meet immediately upon notification of a patient who might have a discharge issue to assess the status of the patient, access needed services, and locate relatives or proxy-decision makers, to further the patient’s care and ensure a smooth, timely discharge.
It is not enough for a safety net hospital to merely provide access to services. As an acute care hospital with high demands for its services and a high census, it is important to treat patients when the hospital is the most appropriate setting, but it is also necessary to effect safe, timely, appropriate discharges.
--- Darlene Ebert, General Counsel, Denver Health