9. Coordinate Care From Hospital to Hotel
Patients as collaborators: Clinical Coordinator Diana Peterson, Dr. Anwar Tandar, and patient Paul Dorius discuss same-day discharge options together.
Connecting everyone from hospital physicians to hotel staff, so cardiac patients can go home sooner
Jeremy Fotheringham had a question. The former bedside nurse and current director of Cardiovascular Services had discovered that a few forward-thinking hospitals were offering same-day discharge to some of their more stable cardiac patients, and he wondered why our hospital wasn’t doing the same.
The research he’d found from the Journal of American College of Cardiology indicated that same-day discharge could work for select patients after simple coronary interventions. In fact, the patient outcomes were decidedly positive—and the costs were clearly lower.1
Finding the right setting for the bedded outpatients to recover helped minimize losses that annually would cost the organization $375,000.
So why wasn’t our hospital advancing the practice of same-day discharge? And why weren’t other hospitals around the country doing it, either? While there were issues of insurance coverage and protocol that had to be addressed to make it possible, the real issue came down to one simple truth: changing clinical care protocols in a large academic medical center isn’t easy. To succeed, Jeremy realized he’d need clear protocols and creative partners throughout the institution—from administrators and physicians to nurses and support staff. His first step? Convincing physicians that it was the right thing to do for the hospital, and, more importantly, for our patients.
Develop evidence-based protocols
To get started, Jeremy partnered with one of our hospital’s most forward-thinking interventional cardiologists, Dr. Anwar Tandar, to create strict criteria for selecting patients. Based on published research about same-day discharge after coronary interventions, this evidence-based protocol showed the hospitals physicians, administrators and risk management specialists just how selective the process would be—and how little risk would be involved.
Next, they pulled in a nurse coordinator to identify same-day discharge candidates, educate them about the option of going home sooner and work through any insurance issues with them prior to being admitted. “It’s so important to identify the right candidates,” says Jeremy. “The worst thing we could do is send a patient home and have something go wrong when we could have intervened. That’s always on our mind.”
But selecting candidates was just the beginning. Dr. Tandar and Jeremy also had to decide how a final determination for same-day discharge would be made. That’s where collaboration with the patient came into play. Although our team could pinpoint the best treatment and discharge option based on everything we knew about a patient’s personal characteristics and anatomy, the patient needed to be a key collaborator in deciding whether it was the right thing to do.
As the final collaborators in our same-day discharge project, our patients take their role seriously. After being informed that they were candidates for same-day discharge, most patients wanted to know the research behind it, just like our clinical team had wanted to know. They also did their own independent fact finding, so that the vast majority of candidates came to their procedures fully informed—and excited about the possibility of leaving the hospital before nightfall.
Collaborate beyond hospital walls
As we worked through our protocol, we also realized that leaving the hospital doesn’t have to mean going home. And with cardiac patients coming from all over the region, the nation and even the world, we needed a creative solution to make same-day discharge possible for anyone who qualified. We found our answer right down the street, at our University Guest House hotel.
“It’s a win for everyone,” says Dr. Tandar. “Our patients love it, and we like knowing that they’re nearby.” To make the process seamless, our nurse coordinators arrange all the details of the patient’s guest house stay, and even better, patients don’t have to worry about an additional bill from the guest house, because we cover these costs.
Saying farewell to our same-day discharge patients doesn’t mean saying goodbye. Patients get a follow-up call the very next morning from the physician who did the procedure or the nurse coordinator who helped them through every step of the process. Issues are addressed immediately and proactively to further ensure the safety of the patient. We also call them at 30 days post-procedure to assess their progress.
“We made it happen by creating a great team from the very start,” says Jeremy. “All of us were able to break from tradition and do something new that made sense for our patients.”
What sorts of innovations, like this, are you employing in your hospital? Tell us your experiences.
1Patel M, Kim M, Karajgikar R, et al. Outcomes of Patients Discharged the Same Day Following Percutaneous Coronary Intervention. J Am Coll Cardiol Intv. 2010;3(8):851-858.