May 21: Observation rounds with case managers
Today I had the chance to spend some time with two of our case managers, Robin and Cindie. In particular, Robin and Cindie work with Dr. Galvi, our medical director of Care Coordination, to help ensure that every patient who is admitted is placed in the appropriate “status” — inpatient or observation.
Simply put, in the hospital every day all of you are working together to make sure that the right care is given to the right patient at the right place at the right time. We certainly don’t want patients to be here any longer than they have to and our focus on every admission is already on planning the safest and most efficient transition home.
One of the biggest shifts we have noted recently is a careful look by payers on whether certain patients, based on “clinical” criteria, would be better served if they were in observation status versus inpatient status. This significant “push” has led to record levels of patients in observation status in hospitals throughout Banner, including Banner Good Samaritan.
The fact is these patients are still placed in “inpatient beds” and cared for by resources we all allocate. But, of course, hospitals are reimbursed at a lower level for “observation” patients. What Robin, Cindie and a large team at Banner Good Samaritan are now working on is how to best position the center to better manage these patients in the safest, most efficient way possible.
Their strategy is as follows:
1. Work with the ED and Hospitalists to ensure that all patients are placed in the correct “Status” on Point of Entry. With a clinical manager in the ED 24/7, they should be able to collaborate with our providers and nurses to make sure we are 100 percent accurate. The “misplacement” of these patients in the wrong “status” leads to significant “inefficiency” and unfortunately can also lead to lower reimbursement and denials by payers.
2. Ensure that all patients placed in Observation Status are admitted to the Banner Good Samaritan “Observation Unit.” Cindie works specifically with this unit to ensure that all resources are completely focused on highly efficient and safety throughput process. If patients can transition from the hospital in the most efficient manner, this leads to safer patient care and higher patient experience. There is no doubt that the less time a patient has to spend in a hospital, the less chance there is of unsafe events such as hospital acquired infections and falls occurring. Moreover, this also allows hospitals to appropriately allocate resources for the right type of patient. Having patients appropriately placed in the Observation Unit at BGSMC allows the right care to be delivered to the right patient at the place at the right time. It’s the right thing to do.
Today, Cindie and Robin informed me that out of the 15 or so patients in Observation Status this morning, only six were in the Observation Unit. However, they were confident that with a highly coordinated approach among CMs, providers and nurses, in the next 12 weeks, a reliable process would be implemented to improve our outcomes.
Banner Good Samaritan is a Place of Possibilities. Cindie and Robin are great examples of how each one of us can contribute to the future growth and success of this hospital that many of you call “home.”
I look forward to the Possibility of Improvement in the important area of managing throughput and, in particular, our patients in Observation Status. At the end of the day we are all committed to ensuring that our patients transition out of the hospital in the safest way possible. This is the right thing to do. Thank you Cindie and Robin for allowing me to take a glimpse of your world at BGSMC today. Thank you for your contribution.
I leave you with this: How are you contributing to Banner Good Samaritan today, this Place of Possibility? I look forward to hearing your stories.
Steve Narang, MD, is the chief executive officer at Banner Good Samaritan Medical Center.