Grafton James, Bowen Brady Helene, Kelly Joanne, Kelly Margaret, Lang Kathleen, Wolski Paula, Ray Soumi, Loescher Cori, Pearson Madelyn, Mendu Mallika
James Grafton, MSN, MHA, RN, CCM, is director of care continuum management at Brigham and Women's Faulkner Hospital in Boston, MA. He is currently pursuing his doctorate in nursing at the MGH Institute of Health Professions in Boston, MA.
Helene Bowen Brady, DNP, MEd, RN, NPD-BC, NEA-BC, is a nurse scientist at Brigham and Women's Faulkner Hospital in Boston, MA, and adjunct faculty, Young School of Nursing, Regis College, Weston, MA. Her research interests include nursing peer review, evidence-based practice, shared governance, and nurse residency programs.
Prof Case Manag. 2023;28(6):262-270. doi: 10.1097/NCM.0000000000000658.
The postacute landscape has been challenged since the onset of the COVID-19 pandemic by staffing shortages and a decline in postacute bed availability. As a result, patients in acute care hospitals are experiencing longer lengths of stay (LOS) and case managers (CMs) are managing increasingly complex discharge plans. This project involved the design and implementation of a modified Early Screen for Discharge Planning (ESDP) tool to support prioritizing patients with complex discharge needs, with the primary outcome of decreasing LOS.
The project took place in a community teaching hospital, part of a large academic health system in the Northeast, United States.
The project was designed as a prospective controlled study (between September 1 and November 30, 2021) with defined intervention and control cohorts, involving a modified ESDP electronic health record-based score including self-rated walking limitation, age, prior living status, and mobility level of assist. A modified ESDP score of 10 and greater indicated that patients would benefit from ongoing CM support, whereas those with an ESDP score of less than 10 were unlikely to have discharge planning needs. Participants were adult patients on medical and surgical inpatient units.
The project included 718 patients, 376 and 342 in the intervention and control cohorts, respectively. The modified ESDP performed comparably with the standard ESDP (14% discrepancy, with all patients appropriately identified for CM services). Implementation of the modified ESDP led to 53.5% of patients screening out of CM services, thereby increasing the time CMs were able to spend on complex discharge planning and was associated with a trend in LOS reduction (0.55 days).
The findings of this project demonstrate that implementation of a modified ESDP can improve CM efficiency and improve hospital throughput. Given the unprecedented capacity challenges in both the acute and postacute settings, there is a need to implement CM workflow strategies that will optimize the effectiveness of critical resources, while ensuring that patients' complex discharge needs are met.
自新冠疫情爆发以来，急性后期护理领域面临着人员短缺和急性后期护理床位可用性下降的挑战。因此，急性护理医院的患者住院时间延长，病例管理人员（CM）正在管理日益复杂的出院计划。该项目涉及设计和实施一种改良的出院计划早期筛查（ESDP）工具，以支持对有复杂出院需求的患者进行优先排序，主要结果是缩短住院时间。
该项目在美国东北部一个大型学术医疗系统的社区教学医院开展。
该项目设计为前瞻性对照研究（2021年9月1日至11月30日），有明确的干预组和对照组，采用一种基于电子健康记录的改良ESDP评分，包括自评步行受限情况、年龄、先前生活状况和辅助移动水平。改良ESDP评分为10分及以上表明患者将从持续的CM支持中受益，而ESDP评分低于10分的患者不太可能有出院计划需求。参与者为内科和外科住院病房的成年患者。
该项目包括718名患者，干预组和对照组分别为376名和342名。改良ESDP与标准ESDP表现相当（差异为14%，所有患者均被正确识别为需要CM服务）。改良ESDP的实施导致53.5%的患者无需CM服务，从而增加了CM能够用于复杂出院计划的时间，并与住院时间缩短趋势相关（0.55天）。
该项目的研究结果表明，实施改良的ESDP可以提高CM效率并改善医院吞吐量。鉴于急性和急性后期护理环境中前所未有的容量挑战，需要实施CM工作流程策略，以优化关键资源的有效性，同时确保满足患者复杂的出院需求。
