Children with complex conditions need additional time, medical care and rehabilitative services for recovery after hospital discharge. However, unique challenges persist in finding post-acute beds and the appropriate care.

The 2014 study Pediatric Post-Acute Care Hospital Transitions: An Evaluation of Current Practice, the first known to detail frequent use of admission and discharge practices for U.S. pediatric hospitals, found variability exists in transition practices. As hospitals take a harder look at transitional care strategies to address value-based care coupled with aging adults, children must be considered.

THE PROBLEM

At Children's National Health System in Washington, D.C., case managers placing children with specialized needs often encountered facilities ill-equipped to care for certain conditions and lacking in pediatric nurses, beds or appropriate medical equipment, for example, feeding tubes and adapters.
 
Another challenge was finding local subacute care. Case managers spent extraordinary time addressing these issues in addition to printing and faxing documents – medical history, progress notes, discharge summary and more in the patient's electronic record – to providers. Follow-up calls were placed to ensure receipt and if additional information was needed. Incessant waiting ensued to learn whether the patient was accepted.
 
PROPOSAL

Two years ago the health system decided to reconfigure its post-acute care transitions to achieve seamless patient handoffs. The institution turned to a more strategic use of technology to eliminate time-consuming clerical activities and match the right facility to support the patient's healing journey. Children's National decided on care coordination technology vendor Ensocare.
 
MARKETPLACE

There are many care coordination systems on the market. Besides Ensocare, vendors include Allscripts, b.well, Caremerge, Imprivata, MyHealthDirect, PatientPing, pMD and Seremedi. This past month, Microsoft revealed plans to bring its own care coordination tools to market.
 
MEETING THE CHALLENGE

Ensocare Transition is care coordination software that enables Children's National Health System case managers and discharge planners to connect patients and their families with the appropriate discharge resources fast and efficiently.

The discharge planners use the software for all existing patients who either need specialized resources at home specific to their condition or require placement and transition support to sub-acute care and rehab facilities.
 
"Previously, our case managers placing children with specialized needs often encountered facilities ill-equipped to care for certain conditions and lacking in pediatric nurses, beds or appropriate medical equipment," said Sabrina Smallwood-Mason, RN, nurse lead and payer reimbursement analyst, denials and appeals, at Children's National Health System.

"Another challenge was finding local subacute care," she added. "The case manager spent extraordinary time addressing these issues in addition to printing and faxing documents to providers."
 
In using the care coordination software over the last two years, Children's National is disseminating those same documents bundled in 237 custom referral packets monthly to the right, matched provider. The packets also include the last three days of inpatient stay and the patient's demographics and insurer information. The health system also is introducing Ensocare to its outpatient case managers to help provide new resources to patients and families.
 
Ensocare Transition is embedded within the health system's Cerner electronic health record system.
 
"If the two systems weren't compatible, automated discharge planning and smooth post-acute care transitions simply would not work," Smallwood-Mason explained. "The integration eliminates the need for faxing, repetitious phone calling and other time-consuming clerical activities.

"Once the discharge planner selects and customizes the appropriate referral placement packet for the patient, the employee can then move to the next step of selecting the appropriate clinical and service-related vendors who best fit the clinical and psychosocial needs of the patient," she added.
 
Within seconds, that selected patient-specific packet information is transmitted to the right, matched facility to support the patient's post-care healing journey.
 
RESULTS

As mentioned, using the care coordination hospital discharge system, 23 Children's National case managers today can disseminate key documents bundled in 237 custom referral packets monthly to the right provider.

Response time averages 30 to 40 minutes from 80 percent of contracted skilled nursing, rehab, home health and other eligible providers, who are more responsive helping children transition to post-acute care facilities, Smallwood-Mason said.
 
"Case managers previously completed referrals sent to providers by faxing documents printed from the electronic record,” she added. ”This faxing activity was time-consuming and overwhelming by nature of the sheer volume of pages per patient."
 
In addition, since faxes were not always transmitted securely, case managers placed follow-up phone calls to ensure receipt, she said.
 
"Today, they no longer have to perform both tasks and the upshot is increased productivity," she said. "The system permits the case manager to view the time and date of when the referral is opened, and when the provider has accepted, considered or declined the request. The case manager can communicate via text with any identified matching post-acute care provider as needed."
 
The care coordination software also enhances information accuracy, she said.
 
Children's National also achieved a significant cost savings for the department by eliminating paper purchases, overtime and clerical staff hours, she added.
 
While the same clinical information is captured as with any referral, documents such as charity applications can be obtained for the patient or family member to complete, alongside captured financial documentation.

On another front, it is fair to say that prior to using the care coordination software, completing a referral was not seamless, Smallwood-Mason said. The software allows the case manager to see what is going on with the referral throughout the process, eliminating guesswork, she explained.
 
"Prior to the software, time for referral completion could be variable, from hours to days in some instances," she said. "The need for communication via phone was a must to verify if the referral was received, if all necessary documents necessary for the referral were received, and also when services would be provided. This was an issue, as it required the case manager to be available to receive the phone calls from providers."
 
ADVICE FOR OTHERS

"I would tell anyone struggling with the clerical inefficiencies that are inherent to the 'way we've always done case management' to consider just how much time you can free up by turning to technology solutions," said Smallwood-Mason. "A lot of case managers believe that the technology will 'take their jobs' or replace them."
 
In fact, letting technology handle those things that can be automated gives the case manager more time to spend face to face with patients, she said. It's the reason most joined this profession, to help people – standing at a fax machine eight hours a day isn't helping people.

Twitter: @SiwickiHealthIT
Email the writer: bill.siwicki@himssmedia.com