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Hospital Learns to Point, Click and Refer
September 2006
For case managers, fax machines often are a constant companion-but not a close friend. That's certainly how case managers at Lawnwood Regional Medical Center & Heart Institute, Fort Pierce, Fla., felt about the machines.
The case managers-who are registered nurses-are tasked with finding long-term care for some patients who have been discharged form the hospital. Due to physical or mental illness, these patients need to be admitted to skilled nursing and long-term care facilities.
But the case managers, instead of focusing on patient needs, had to spend the bulk of their time collecting information, searching for long-term accommodations and finally parking themselves next to fax machines, sending stacks of paper documents out, or waiting for a stack to come in.
The referral process could take days, which left patients and their families in limbo. It also kept Lawnwood case managers from spending time with their patients as well as helping others, says Dianne Pedersen, R.N., director of case management at the 341-bed hospital.
So last year, Lawnwood decided to automate the task of finding long-term care for its patients by deploying a Web-based system from Chicago-based Extended Care Information Network.
"I saw a huge advantage of limiting the paper process," Pedersen says. "We wanted to utilize case managers for their nursing and critical thinking skills and less for faxing and copying."
The system-which is connected to a central Web site hosted by the vendor-enables case managers to use online forms to enter all the necessary medical information and then electronically send it to outside facilities. The application also sends certain clinical data to the health insurers for approval, and enables Lawnwood to exchange messages with payers and long-term care facilities electronically.
Though the hospital has yet to do a return on investment analysis of the Web-based system, it has reduced the length-of-stay for patients needing extended care by three days, Pedersen says. In addition, the system has increased productivity of the 30 case managers, and the facility has already eliminated the costs of a half of a full-time equivalent salary, Pedersen says. And more important, it has freed up time for case managers to put their caregivers' skills to use, she adds.
"Now they can be case managers rather than only discharge planners," Pedersen says. "They can perform functions as R.N.s and facilitate throughput. Now they have more time for consulting with families and physicians."
Hitting the pavement
Before the Web-based referral system was implemented, complex cases required long-term care facilities to send their own nurses to Lawnwood to review patients' medical records, and meeting those caregivers and reviewing the record was another time drain for the hospital's case managers, Pedersen says.
But standardized forms help ensure long-term facilities have all the necessary information to decide whether they can accept a patient. Lawnwood has integrated the online application with its admission-discharge-transfer system, so the information is pulled from that system and used to populate the forms, which then can be transmitted directly to a number of long-term facilities that might be able to admit the patient. Previously, the information had to be sent separately to each organization.
Most facilities in the area are connected to the referral network and accept the information electronically, though some still need to have the forms faxed over, Pedersen says.
After a long-term care facility reviews the referral, they typically respond though the Web site. Lawnwood's case managers are notified via an e-mail or text message to a pager if a facility will accept a patient. Most organizations get back to the hospital in less than 24 hours, and many within an hour or two, Pedersen says.
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