Effective case management is the cornerstone of promoting quality care and achieving cost-effective outcomes at every hospital. The collaborative nature of case management, from admission through discharge and beyond, affects the health of both the patient and the hospital. At Good Samaritan Hospital (GSH), we have a long-standing history of providing quality healthcare and services to the communities of northeast Baltimore. As one of Maryland’s fastest-growing hospitals, we cannot afford to fall behind in our caseload, utilization, quality and discharge management processes.

GSH discharges about 17,000 patients a year, and has enjoyed a growth rate of greater than 20 percent since 2003. However, along with this exciting pace of expansion came some growing pains. The hospital had to address challenges of infrastructure and capacity issues, such as length-of-stays, an increase in denied days, a decrease in its case-mix index, and Medicare regulations and penalties related to disposition coding. With manual processes the only option for managing these complex issues moving forward, we made the decision to streamline workflow and information management with a care management software solution.

Seamless Implementation, Immediate Results

For years, GSH approached the issues of care management with a manual system that provided very little valuable information and required labor-intensive reporting methods and extensive maintenance. We considered finding a solution with the proper mix of flexibility and functionality vital to the objective of streamlining our communication processes. Our hospital has a reputation for practicing a holistic management style where the staff and management collaborate to drive the decision-making process, so we wanted a system that could be tailored towards our organizational needs. In 2003, after an exhaustive search, we selected the Canopy Care Management solution by Allscripts.

As a result of this improved process, we are also working more seamlessly with payors and are receiving more timely payments.

Thus far, the system has proven itself highly capable of streamlining and automating the case, utilization, quality and discharge management processes of our hospital. Even though this was the first Web-based application service provider solution of its kind introduced to our healthcare facility, implementation was relatively simple. Installation required minimal upfront capital investment, IT infrastructure support, and relatively little aid from our internal IT resources. Our staff expressed a minimum of concern while they transitioned to the new system and, thankfully, a short learning curve facilitated our decision for a hospitalwide go-live; system users were on the same page very quickly.

More Beds, Fewer Red Flags

The new software helped us address our need for improved communications with prioritized length-of-stay management. Our goal was to gain efficiencies through better communication and transparency of opportunities, while also creating an environment of shared accountability. To improve the focus of our case managers, we used the system to create a priority list with built-in alerts for patients who, for instance, have an actual length-of-stay longer than their estimated length-of-stay. The solution gives us the flexibility to flag patients who do not meet established criteria, leading to immediate review by physician advisors and case management teams.

A report is then created listing patients who do not meet criteria, and the report is sent via e-mail to medical staff and hospital leaders, who can then set well-informed priorities for daily activities. Discharge processes cannot be improved without first identifying barriers to discharge and gaining a clear understanding of needs. We wanted care providers and ancillary departments to self-organize their workflow around prioritized needs, so when doctors come to the floor or ancillaries schedule tests and treatments, they would know precisely where to focus.

Through the new system, case managers and social workers identify known and anticipated discharges, and indicate any existing barriers and activities needing to be completed before discharge. This enables us to establish specific priorities for everyone involved, from the case manager and social workers, to cardiologists and nurses. Each person knows what to check for in order to facilitate discharges. Also visible are necessities and barriers related to progressive care, such as a patient awaiting an EKG, PICC placement, PT evaluation, neurology consult and other pending items.

We’re not only improving communications within the case management department, but also throughout the rest of the hospital as well. Our care management system serves as an information dashboard and allows management to dive into GSH to monitor patient flow and capacity for bed control. With improved visibility, we can better forecast and plan for patient-flow issues, and thus avoid being forced into an ED bypass situation, limiting direct admits or reducing the OR schedule.

Streamlining Operations, Saving Money

As a result of this improved process, we are also working more seamlessly with payors and are receiving more timely payments. We used to conduct case reviews via telephone, but after implementing the new system, we immediately began auto-faxing our case reviews to payors. A case management system made a significant impact on our admissions and length-of-stays. In the first six months, we saw a 27 percent reduction in length-of-stays from the time patients were identified as “not meeting admission criteria,” and a 40 percent reduction from identification of patients “not meeting continued-stay criteria,” until discharge.

After 12 months, the time it took to get patients discharged after it had been determined they did not meet criteria dropped to 1.16 days, and the percentage of these patients discharged within one day increased from 61.9 percent to 85 percent. Previously, case managers identified approximately 85 percent of non-admissible patients on the first day of their hospital visit, 7.5 percent by the day after and the remaining 7.5 percent by their third day. After 12 months using the Allscripts product, greater than 95 percent of non-admissible patients were identified as such during the initial day of their visit.

In addition, the first six months live on the new system brought a 50 percent decrease in denied days. More than six payor organizations have paid compliments to GSH and expressed their appreciation for the clear and organized information that is generated by the new process.

A Well-recognized Resource

Our hospital’s ability to creatively and effectively design the care management process around the new solution has garnered rave reviews by industry experts. The Advisory Board Company, which provides best-practices research and analysis to the healthcare industry, identified GSH’s use of the new application as a national best practice for throughput and utilization management. With the transition to an automated, software-based solution, our case management department became the eyes and ears of the hospital and a valuable component of its overall vitality and success.

Because all of the information necessary for our staff to perform at peak efficiency is now available, the entire hospital is equipped to meet staff expectations.

We couldn’t possibly have anticipated the level of value the automated system has demonstrated to our entire organization, in addition to how valuable it has proven to the case management department. Because all of the information necessary for our staff to perform at peak efficiency is now available, the entire hospital is equipped to meet staff expectations. The case management team recognizes that the organization is undergoing a process of dynamic change. To address the challenges shifting toward enhanced case-management brings, the new solution has become a key resource. By boosting our use of reports generated by the automated system, we hope to discover additional cutting-edge methods for managing length-of-stays and resources optimization.