1. References
2. Sample Patient Admission
3. INTRODUCTION
3.1. Description
3.1.1. Discharge Needs
3.1.1.1. Home Care Needs: Upon discharging from the hospital, patients often require follow up care to be performed in their residence. Visiting RN's, Physical Therapists, Occupational Therapists, and Caregivers are examples of the types of arrangements that need to be made.
3.1.1.2. Medical Equipment and Supplies: Patients may need equipment during their recovery or permanent installations in their home to assist with daily activities. Wheelchairs, walkers, raised toilet seats, hand rails, commodes, and crutches are examples of equipment. Sanitary wipes, diapers, Oxygen, glucometers/test strips, and disposable sheets are examples of supplies that are needed.
3.1.1.3. Prescriptions: Patients require medications both during their hospitalization, upon discharge, and sometimes short or long term post discharge. Insurance, accessibility, costs, and understanding of purpose, are all obstacles patients face when dealing with prescriptions.
3.1.1.4. Community Resources: Patients come from all different socioeconomic backgrounds and resources are available within the community for various patient needs. Smoking cessation, disease management, residential assistance, federal/state program enrollment, and rehabilitative services are a few of the resources available to patients in the community.
3.1.1.5. Post Acute Care Centers: Patients who require medical care at a reduced level may need to find a facility to reside both for a short term or long term stay. Skilled Nursing facilities, Assisted Living Centers, Respite Care Centers, and Hospice/Palliative Care Centers are all different options based on the needs of the patients.
3.2. Rationale
3.3. Larger Social Context and Demand
4. STAKEHOLDERS
4.1. RN Case Managers/Social Workers
4.2. Vendors
4.3. Third Party Payers
4.4. IT
5. QUESTIONS AND ADDITIONAL INFORMATION NEEDED
5.1. What is the average length of stay for common diagnoses?
5.1.1. Pepper Resources is an organization that provides "provider-specific Medicare data statistics for discharges/services vulnerable to improper payments. PEPPER can support a hospital or facility’s compliance efforts by identifying where it is an outlier for these risk areas. This data can help identify both potential overpayments as well as potential underpayments" (2014).
5.2. Is this program necessary? What plans do we have in place in order to reduce hospital costs and spending with the implementation of health care reform in 2014?
5.2.1. According to the Huron Consulting Group,"hospitals will be expected to do more, to do different things than they do now and to do it for less. The sooner hospital administrators begin the plan for this, the better their chances will be for managing serious financial challenges successfully" (Gideon, n.d.). This program has the potential to save the hospital money in order to avoid serious financial challenges which will be inevitable in the upcoming few years.
5.3. How can we improve the patient experience prior to, during, and after hospitalizations?
5.3.1. Evaluating the patient experience helps improve care but also can have financial benefits. The goal with the Patient Discharge Assistance Program is to involve the patients from the beginning which will help address any concerns and improve their overall experience. Attached is an organization that evaluates patient experiences and helps guide hospitals on how to use this information.
5.4. How often are patients readmitted and what are the reasons for requiring further hospital care?
5.4.1. According to an article printed in Medical Care, "a readmission may result from incomplete treatment or poor care of the underlying problem, or may reflect poor coordination of services at the time of discharge and afterwards, such as incomplete discharge planning and/or inadequate access to care" (Halfon et al., 2006, p. 974). Improving the discharge process with this program will help to reduce admissions.
5.5. How complicated will this program be to learn and how much additional time and investment will be necessary to train the staff and implement the change?
5.5.1. This program will provide a platform within EMR which will allow all of the patient information and discharge information to be aggregated in one place. Entering the information will be in a logical sequence in order to utilize it during this and further hospitalizations. Porter-O'Grady & Malloch discuss the topic of coaching in that it is an important form of assistance to, facilitate or engage in one-to-one coaching coupled with customized assistance for each venture" (2010, p. 3554). Without proper training and mentoring, implementation can be disastrous, but through effective preparation the staff can transition seamlessly.
5.6. What is the anticipated outcomes?
5.6.1. The Patient Discharge Assistance Program will help to streamline the discharge planning process, improve the patient experience, improve patient outcomes, reduce length of stay, reduce readmissions, and save the hospital money. However, these outcomes need to be reasonable and executives need to be patient for results. Weiss & Legrand write, "executives need to exercise some patience so that the new culture can be solidly embedded in the organization and firmly established as the way things are done on a daily basis" (2011, p. 4177). In an appropriate amount of time these outcomes can be measured and analyzed in order to evaluate success.
6. EVALUATION AND OUTCOME MEASURES
6.1. Patient Satisfaction
6.2. Length of Stay
6.3. Readmission Rates
6.4. Hospital Savings
6.5. Employee Satisfaction
7. FORCES IMPACTING SUCCESS AND POTENTIAL BARRIERS
7.1. Organizational Forces Impacting Success
7.1.1. Management Support
7.1.2. Corporate Culture
7.1.3. Clearly Defined Achievable Outcomes
7.1.4. Performance Management
7.2. Barriers to Success
7.2.1. Employee willingness to participate
7.2.2. Perceived value
7.2.3. Financial Investment
8. IMPLEMENTATION PLAN
8.1. 6 months pre-launch
8.1.1. Idea Presentation to Executives
8.1.2. Hire researchers to collect data and resources
8.1.3. Hire developers to build the interface
8.2. 3 months pre-launch
8.2.1. Select pilot hospital for launch
8.2.2. Prepare IT for training and trouble shooting
8.2.3. Educate hospital staff
8.3. 1 month pre-launch
8.3.1. Evaluate success of program from pilot hospital
8.3.2. Select additional hospitals for implementation
8.3.3. Train staff and introduce "Best Practices"
8.4. LAUNCH
8.5. 1 month post-launch
8.5.1. Employee Satisfaction survey
8.5.2. Patient Satisfaction survey
8.5.3. Best Practices
8.6. 3 months post-launch
8.6.1. Evaluation of Employee program utilization performance
8.6.2. Length of Stay Data Analysis
8.6.3. Feedback from Third Party Payers and Vendors
8.7. 6 months post-launch
8.7.1. Readmission Rate Analysis
8.7.2. Hospital Management Evaluation
8.7.3. Cost Savings Analysis
8.7.4. Select additional hospital for utilization
8.8. 1 year post-launch
8.8.1. Program Outcome Analysis
8.8.2. Baseline vs. Where we are today
8.8.3. Hospital Savings Analysis
8.8.4. Employee and Patient Satisfaction Analysis
8.8.5. Re-evaluation meeting with Management, Department heads, and implementation team
8.8.5.1. Create and implement Year 2 timeline with barriers, outcome measures, and goals.