We have improvement work ongoing in our Case Management Department. I have visited the ‘bed brain’ area several times in the last month to see and hear a first-hand account of the improvement work. The ‘bed brain’ area is where the beds are assigned, tracked and managed in order to accept patients in an orderly and safe manner. It looks a lot like an air traffic control room in a busy airport. The center of this activity is located on the second floor in the McLeod Tower.
Prior to the improvement work in this area, all disciplines of Case Management worked somewhat independently. The work was specialized and done separately many times. Even though the roles of the various people differ, there is one common thread – to focus on the timely and safe discharge of the patient for each episode of care. One of the biggest barriers to that goal is a lack of ‘real-time’ usable information.
The ‘As Is’ step in our improvement process identified that we had the expertise in terms of people and we were gathering the needed information … yet due to a lack of collaboration in the flow of the work, we were unable sometimes to bring all of the pieces together for a pro-active discharge for the patient and family.
One solution was the ‘huddle.” The Case Management Huddle team is comprised of the Care Coordinator (team leader), the Utilization Management Nurse, the Compliant Documentation Specialist, and the Discharge Planner (Social Worker). Each team is assigned to specific patient populations. This allows them to be very familiar with physician practice patterns, disease processes, reimbursement and appropriate discharge plans. A huddle of 30 to 45 minutes requires each discipline to be prepared with the most pertinent update of information in order to facilitate a more timely and safe discharge plan for patients in a particular nursing unit. Some of the information shared during the huddles … includes the needs of a patient after discharge, the home environment, approvals from insurance companies for home care, and any social issues affecting the patient at home.
In this improvement work the team has also sought to standardize the structure of the Case Management huddles in order to assure consistent dissemination of information. Using this format developed through two Rapid Improvement Events (RIEs), we have seen an overall reduction in Length of Stay (LOS) for patients, less wait time and an enhanced level of teamwork and mutual respect among all team members. A side benefit of the Rapid Improvement Events (RIEs) was an unexpected time savings for members of the team. Due to the patient focus and population focus of each huddle team, data that was needed could be obtained during or immediately after the huddle. This step further enhanced our productivity and has enabled the teams to participate in the Case Management huddles without a negative impact on their work.
If you would like to know more about this improvement work, Larry Adams is our facilitator from Operational Effectiveness, Lesli Kennedy is our team leader, Cassandra Brunson is the process owner and the director of Discharge Planning and Susan Pickle is our Value Stream Team leader.