The path to consistent, quality patient care progression sounds simple enough:
1. Set and meet accurate length of stay targets based on appropriate DRGs—begin with an end in mind and proactively manage toward that end.
2. Focus unit care teams on clear, appropriate care progression plans for all patients.
But admissions processes often do not capture and disseminate an appropriate target length of stay and DRG in a way that informs expectations for treatment and documentation. Thus caregivers face challenges choosing appropriate goals for managing patient progression so that everyone is working toward that goal. The resulting delays in care prolong length of stay, increase costs, frustrate patients and caregivers, and increase the possibility of preventable harm. Inconsistent care progression can also increase readmissions, as divergence from appropriate and timely care plans increases the risk that the need for treatment will reoccur.
There are several key tools and disciplines unit care teams can adopt that dramatically improve consistent delivery of quality care, with resulting benefits in efficiency and patient satisfaction:
Standardize Your Patient Progression Plans: Create and track progression against standardized, patient-appropriate care plans with continuously visible goals and progress. Over time, this helps collaboration for quality care become easier and more reliable and predictable.
Assess and assign appropriate DRGs and length-of-stay targets. The refrain is so common we often forget how important it is: Effective discharge begins at admissions. That means having everyone on the care team know, understand and agree as to when each patient should leave the hospital with appropriate treatment. Hospital leaders must commit to the discipline of setting accurate and appropriate length-of-stay targets.
Have care teams consistently work toward those length-of-stay targets. The progression of quality patient care on the unit depends on care teams always seeing and working toward accurate targets for length of stay. Length-of-stay based care progression should become the focus and culture of care teams.
Make DRG and length-of-stay targets specific to your hospital. Admissions staff often look up DRGs and set care targets based on national averages that may vary considerably from the observed and expected targets for a specific hospital. Invest the time to adopt DRG guidelines that match the observed and desired case mix and associated length-of-stay targets specific to your hospital.
Adopt daily care progression huddles on every unit. It might be time to rethink your daily unit safety or shift meetings. Effective patient progression huddles gather the full unit care team for each shift to clearly understand patient progression and care goals, as well as escalate any issues outside their control to executive leaders for resolution.
Make O/E ratios a critical performance measure. Once you’re setting accurate and appropriate targets, make sure you’re continuously measuring observed (actual) versus expected length of stay. When your O/E ratios are below 1, your hospital is optimizing care progression and maximizing reimbursements and margins.
These recommendations aren’t exhaustive, but we’ve seen many hospitals adopt more precise length-of-stay targeting as the foundation for improving care efficiency, outcomes and experience. Progressing the patient’s care by focusing the care team on the immediate patient needs while anticipating and preparing for the next steps is the key to delivering the right care, reliably, in a predictably appropriate amount of time.
Solutions to Help Improve Care Progression, Quality and Experience
There are solutions focused specifically on establishing consistent, reliable progression of quality patient care on your units an across your hospital. Sustain top performance in all areas of care delivery with a range of options, from targeted solutions for unit patient progression to comprehensive solutions for clinical transformation.
Care Progression: Gives hospital unit care teams the ability to quickly and reliably assign correct DRGs and length-of-stay targets, ensuring appropriate care and reimbursements. This package combines training, technical services and software.
Care Progression Optimized: Overcomes the common barriers to unit care progression, empowering coordinators to deliver the best care consistently and efficiently. It combines optimized care progression processes with powerful software that, in a single place, informs and prompts them to take all the right next actions in their patients’ care plans.
Hospital Operating System – The Complete Transformation
Solution: Establishes a hub-and-spoke “production model” for care that dramatically improves patient care, throughput and experience. This complete transformation solution comprises a program for positive culture change, a new centralized care coordination model, and software built to ensure reliable and predictable quality care for every patient.
(A final note. We’re excited to have launched a new podcast called Who Cares? Hospital Talk. It showcases the positive, passionate healthcare heroes who work hard to improve patient care and experience in hospitals. Check it out here.)
Karl Straub is President and CEO at Care Logistics.