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Streamlining patient review

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   November 2011

Morehead Memorial expands care-management program, ensuring appropriate patient care.

Challenge

When Renee Angiulli, director of case management, came to Morehead Memorial Hospital in 2008, each nurse in the staff performed reviews using InterQual Criteria that had been manually embedded in Morehead’s health information system. However, the organization, a full-service, not-for-profit community hospital located in Eden, N.C., had not opted for formal training in applying the InterQual Criteria for the staff. As a result, there was tremendous variation in compliance, accuracy and how data was applied.

In addition, Morehead’s high observation rate – around 32 percent – far exceeded its benchmarks for that status. The rate signified that patients were being assigned to observation when it may have been more appropriate to discharge them from the ER or to admit them for inpatient care. 

Solution

Renee Angiulli, R.N., B.S.N., M.H.A., C.C.M., is director of case management at Morehead Memorial Hospital in Eden, N.C.

Working with a staff that was concerned about changing to new, unfamiliar technologies, Angiulli focused on a gradual transition rather than a complete overhaul. Morehead decided to implement CareEnhance Review Manager and focus on automating the clinical decision review process and streamlining workflows. Morehead also opted for training services and the InterQual Interrater Reliability (IRR) Suite, an online tool for evaluating consistency from reviewer to reviewer. 

Upon completing product demos, a McKesson trainer led an on-site classroom session with staff and a live walk through of the product to show staff members the full review process. According to Angiulli, the on-site training was critical, and the McKesson trainer was essential to the learning process and the creation of a continuous learning environment.

In addition to benefits experienced as a result of the training process, Morehead experienced immediate case-management process improvements as a result of Review Manager; a key improvement was a more efficient patient-tracking process with McKesson’s HL7 feed. Not having to rely on a paper census for patient tracking greatly increased efficiencies for the case-management department.   

“The word ‘change’ caused great anxiety amongst my staff – they were used to their way of doing things and didn’t realize the inaccuracies our methods were creating,” says Angiulli.

Results

Seventeen months after Morehead implemented Review Manager with IRR training and expanded its care-management program, the organization has become significantly more compliant with review processes and is better prepared to ensure appropriate patient care.

Increased appropriate, timely and quality care:By automating reviews and assigning well-trained case managers to cover the ER, Morehead has increased the initial review rate by 20 percent and decreased the incidence of patients going to the floor in the wrong status.

Lowered observation rate:Morehead’s observation rate dropped from 32 percent in 2008 to 19.3 percent in 2010, indicating that more patients are avoiding unnecessary care and expense while the hospital is receiving revenue from appropriate hospital admissions. Combined with an aggressive second-level review company, this has added an average net impact of $150,000 to $200,000 per month.

Full compliance and increased efficiency:The staff is able to review criteria sets on their computers, which has increased efficiency and enhanced compliance with the review process.

Continued learning:With the IRR testing application, the staff has been able to maintain a high level of accuracy in applying the criteria.

Reduced risk: Greater consistency in applying evidence-based criteria among care-management staff helps validate medical necessity and minimize medical-necessity audit risks.

Angiulli also sees Review Manager as a means of achieving additional goals, such as transitioning to a paperless hospital. The staff will also continue to use the IRR solution and conduct monthly utilization review meetings and training sessions.

“Now that we have streamlined our review process with Review Manager, I am able to meet with each staff member on a monthly basis to make sure we are on track and compliant,” Angiulli adds. “We are a testament to the fact that transition works, and we have proven that advanced technology along with rigorous training can make a huge difference in workflow and compliance.”            


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