The goal of case management is to create a cost-effective and efficient hospital, which provides comprehensive and effective care for patients. Similar to a puzzle, when even one piece is missing, both the hospital and patients suffer.
QHR Health conducted and implemented a Case Management program assessment and implementation engagement for Memorial Hospital of Sweetwater County (Sweetwater), a 99-bed non-profit regional acute care facility located in Southwest Wyoming. After attending a Webinar on the Two Midnight Rule hosted by the QHR Health Learning Institute, Sweetwater asked QHR to help address a rise in its average Length of Stay (LOS) of about .3 days per year. Contributing issues included staff productivity and efficiency concerns, unrefined processes and inadequate tracking systems.
To begin, the QHR consultant completed a staffing analysis to determine the appropriate staffing needs, maximize coverage, and institute leadership oversight. To drive change, the hospital established a Case Management steering committee, which included the CNO, CFO, director of nursing, director of OB, director of PT, director of revenue cycle and the case management team. The committee determined that three case managers would provide appropriate coverage on a rotating schedule, including a weekend shift, an emergency department shift and a standard 12-hour per day weekday shift. In addition, the Board decided to have the new Case Management team report to the CNO instead of the CFO.
With the Case Management and support teams in place, the hospital instituted new multi-disciplinary rounds with daily meetings that included nursing, physicians and ancillary departments, such as physical therapy, respiratory therapy and dietary. These meetings were crucial in bringing key players together to communicate information necessary to move patients along the continuum of care. Training sessions for the entire hospital staff were scheduled at 7:00 a.m., lunchtime and 7:00 p.m. to give everyone a chance to attend and learn about the project and all the positive changes that would come from this redesign.
Next, the QHR consultant reviewed the current processes for Utilization Review, Discharge Planning, Patient Status Change, Physician Advisor Escalation and Avoidable Day Capture. The hospital began using a new dashboard to monitor the functionality of these processes and to show key indicators for progress and improvement. The hospital established new measurements in the following areas:
Finally, after the assessment, a new Case Management tool was put into place and the QHR consultant helped set up and design the system to optimize its use.
Since the redesign of the Case Management program at Sweetwater, the hospital has experienced improvement in LOS for six months and the hospital leadership continues to be pleased with the revamped department and processes. From January 2015 to June 2015, the hospital reduced its average LOS by approximately .3 days while also increasing volumes. The estimated financial impact of this average LOS reduction is $197,000. The hospital has also looked to QHR for additional engagements to maintain the momentum and continue improving the facility.