The most important people in a hospital are not the physicians, the nurses, or the executives; they are the patients. Taking the time to see the hospital through their eyes can do wonders for the facility, according to Greg Nelson, president of Baptist Leadership Group in Pensacola, FL.
"The overall focus here is moving from provider to patient centeredness," Nelson says.
Basic challenges at any facility include overcoming barriers to discharge, promoting physician buy-in, and increasing patient flow and throughput. In order to address these issues, you also must address the discharge process, says Nelson.
Shorter length of stay means harder discharge planning
The advent of the diagnosis-related group system gave hospitals an incentive to decrease the length of stay.
The average length of stay is two days shorter than it was 15 years, Nelson says. "We are trying now to get our patients home as soon as we can. I understand the financial reason for that, but we must understand the clinical implications," he says.
Stefani Daniels, RN, MSNA, ACM, CMAC, managing partner at Phoenix Medical Management, Inc., in Pompano Beach, FL, says financial implications are not the only reason to reduce length of stay. The acute care setting is a high-risk environment, and patients are safer in a lower level of care or at home. Regardless, the reduction in length of stay has made the discharge process critical. Patients and their families now change wound dressings, administer medications, and monitor progress.
"We expect patients to serve as their own little case managers," Daniels says. "And in most cases, it is unrealistic."
Staff members in every facility must reinforce the discharge plan, make sure that patients clearly understand the discharge instructions, and follow up with patients so they remember what their instructions are.
"Patients remember 10%–15% of the content of discharge instructions even when they are given a brochure and formal instruction," Nelson says.
Having dedicated staff members who contact patients within 48 hours of discharge to remind them of discharge instructions is a great way to ensure compliance with the discharge plan, say Daniels and Nelson.
Because patients are more responsible for their own care than ever before, it makes sense that hospitals should become more patient centered.
"Patients need to know we aren't kicking them out before they are ready to go," Daniels says. "We want to make sure they are in the safest environment."
Multiple patient encounters require teamwork
In the average three-and-half-day stay, a patient will interact with 50 to 55 staff members, according to Nelson. That includes nurses, physicians, housekeepers, food service staff, and maintenance staff. In order to ensure that every patient has a positive experience, all these caregivers must be on the same page.
Making eye contact, showing patience, and taking time to listen and address patients' concerns will make patient feel like they are safe and being taken care of.
"[Hospitals] should demonstrate with every person that touches the patient, that [they] care," Nelson says.
Nelson plans to expand on how the patient-centered approach can improve patient care at the 2010 NICM/ACMA National Conference in San Antonio.
The presentation, "Patient/Family Centered Discharge Planning: Moving from Provider to Patient Centeredness," will discuss practical tactics such as service mapping and rounding with patients.
The session will also talk about the benefits of requiring clinical representatives to call patients at home within 24 to 48 hours of discharge.
This article was adapted from one that originally appeared in the April 2010 issue of Case Management Monthly, an HCPro publication.