- Email: [email protected]
Transforming the traditional discharge planning manual
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Transforming
the
Traditional
Discharge Planning Manual Judith R. Sands, RN, BSN, LHRM, CPHQ, CCM, ARM, CLC
D
ischarge planning resources change frequently, and keeping them current, available, and accessible to case management (CM) staff and others is a challenge. Given the time-consuming and labor-intensive nature of updating, many organizations revise them in preparation for the triannual survey or when they are hopelessly out-of-date. The reality is that CM staff and others involved with discharges have their own personal “little black book” of resources. Those personal reference tools are treated with reverence and guarded like the family Bible. Organizations are challenged to have up-to-date resources available and accessible for staff in all areas. One approach is to transform the traditional paper-based manual into an electronic document and make it available on the organization’s intranet. This approach means that each page of the current paper-based manual must be in electronic format, ending the use of overcopied resources that become difficult to read and “grandfathered in” to each successive edition of the paper manual. This option permits easy and rapid updates when resources and information change.
TCM 66
November/December 2006
The North Broward Medical Center’s discharge planning manual transformation began when all staff acknowledged that the current process of maintaining 27 separate manuals for CM staff, various nursing stations, and one ambulatory clinic was impossible. The cost of each binder and supplies was $24.05, a total of $649.35 for the 27 binders. These resource binders were valued by some and disappeared altogether; others were so well hidden that they were not available when needed. The time and energy involved in locating these manuals to insert updates became exhausting and truly impossible. Updating the manuals was done less frequently, given the numerous barriers, further dissuading use of the resource. To resolve the currency issue, team members identified all the barriers associated with
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Figure 1 CASE MANAGEMENT DISCHARGE PLANNING MANUAL REVIEW FORM Reviewer: __________________________
Return by: _______________________
Instructions: Please review your designated sections and advise if any corrections or modifications are needed. Notations should be made on the draft documents and returned to Elizabeth. 1. NBHD discharge planning procedure 2. HMO & insurance company contacts 3. Abuse & neglect/domestic violence 4. Acute rehab facilities 5. Assisted living facilities 6. Baker Acts & mental health services 7. Durable medical equipment & oxygen 8. HIV/AIDS services 9. Homeless assistance 10. Home health care 11. Home IV infusion & IV antibiotics 12. Hospice/palliative care 13. Meal services and community nutrition resource services 14. Pediatric services 15. Prescriptions: medications, TB, & seizure meds 16. Primary health clinics/ambulatory 17. Private homemaker/companions; nurse’s aides 18. Senior services 19. Skilled nursing facility placement 20. Social service agencies 21. Substance abuse; Marchman Act 22. Transportation, miscellaneous (hurricane, toll-free hotlines, hotels/motels, Broward County Public Health Dept.) 23. Reportable diseases, dental and optometry care 24. Veteran’s services 25. Out-of-area (county transfers) services for uncompensated patients Comments:
November/December 2006
TCM 67
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Page 68
Figure 2 NBMC’S CASE
MANAGEMENT DISCHARGE PLANNING MANUAL IS
ONLINE AND AVAILABLE TO ALL!
This manual is now available on the intranet under the Document Library tab. Visit this tab to locate the manual. • Click on the drill-down menu (+) next to the Discharge Planning folder. • You can view 25 folders organized in alphabetical order. A series of PDF documents are contained in each of these folders. You may print any or all of these documents to use as a resource. If you have any questions or comments, please contact the case management team at ext. 6733. •
maintaining the manuals and their causes. They decided to convert the manual into an electronic format and publish it on the North Broward Hospital District’s intranet, thus extending its accessibility and availability. The subgroup in charge of the manual’s transformation determined that the categories of the paper manual were still relevant and several new sections were needed. A review sheet (Figure 1) was developed and used with each section of the manual to document the review status and progress of the specific section. Current paper-based resources were reviewed to identify items that were still current and should be included, along with a list of resources to be added and the need to search for new resources. Each team member was responsible for designated sections of the manual. A summer intern had the responsibility to type items that were not in electronic format, update and revise those items that were in electronic format, verify that resources entered were current with correct contact information, and perform the research to identify additional resources. Once the information was obtained, the intern collated the information, scanned forms so that they would be available in electronic format, and placed items in the prescribed order by section. The completed electronic manual was forwarded to the CM information services (IS) liaison; she had the manual uploaded to the intranet within days. Education about the manual’s availability and accessibility, including the “how-touse” instructions (Figure 2), was provided in various forms, including placing TCM 68
November/December 2006
announcements about the manual’s availability on the district’s home page; CM departments at sister facilities were alerted to its availability; all district department managers were provided with information in the monthly IS publication distributed at the monthly organizational staff meeting; and CM staff provided hands-on demonstrations to nursing staff. Satisfaction surveys have indicated that employees beyond the CM department are regular users of the resources; in addition, select resources are printed for patients and families. Employees report that they have used the manual to locate resource information for family or personal problems without needing a coworker. Staff in the emergency department and clinics report being able to rapidly provide community resources without having to wait for social work staff, reducing wait times and increasing customer satisfaction. The CM staff was so excited about the transformed resources that they featured it at the hospital’s annual Quality Expo competition, and the project was selected to be a presentation at the South Florida Chapter of the American Society for Quality’s 16th Annual Performance Excellence Showcase. ❑ Judith R. Sands, RN, BSN, LHRM, CPHQ, CCM, ARM, CLC, is the regional manager for case management at North Broward Medical Center in Deerfield Beach, Florida. Reprint orders: E-mail authorsupport@ elsevier.com or phone (toll-free) 888-834-7287; reprint no. YMCM 420 doi:10.1016/j.casemgr.2006.06.009
11/8/06
2:41 PM
Page 66
Transforming
the
Traditional
Discharge Planning Manual Judith R. Sands, RN, BSN, LHRM, CPHQ, CCM, ARM, CLC
D
ischarge planning resources change frequently, and keeping them current, available, and accessible to case management (CM) staff and others is a challenge. Given the time-consuming and labor-intensive nature of updating, many organizations revise them in preparation for the triannual survey or when they are hopelessly out-of-date. The reality is that CM staff and others involved with discharges have their own personal “little black book” of resources. Those personal reference tools are treated with reverence and guarded like the family Bible. Organizations are challenged to have up-to-date resources available and accessible for staff in all areas. One approach is to transform the traditional paper-based manual into an electronic document and make it available on the organization’s intranet. This approach means that each page of the current paper-based manual must be in electronic format, ending the use of overcopied resources that become difficult to read and “grandfathered in” to each successive edition of the paper manual. This option permits easy and rapid updates when resources and information change.
TCM 66
November/December 2006
The North Broward Medical Center’s discharge planning manual transformation began when all staff acknowledged that the current process of maintaining 27 separate manuals for CM staff, various nursing stations, and one ambulatory clinic was impossible. The cost of each binder and supplies was $24.05, a total of $649.35 for the 27 binders. These resource binders were valued by some and disappeared altogether; others were so well hidden that they were not available when needed. The time and energy involved in locating these manuals to insert updates became exhausting and truly impossible. Updating the manuals was done less frequently, given the numerous barriers, further dissuading use of the resource. To resolve the currency issue, team members identified all the barriers associated with
66-68_YMCM420_Sands_CP.qxd
11/8/06
2:41 PM
Page 67
Figure 1 CASE MANAGEMENT DISCHARGE PLANNING MANUAL REVIEW FORM Reviewer: __________________________
Return by: _______________________
Instructions: Please review your designated sections and advise if any corrections or modifications are needed. Notations should be made on the draft documents and returned to Elizabeth. 1. NBHD discharge planning procedure 2. HMO & insurance company contacts 3. Abuse & neglect/domestic violence 4. Acute rehab facilities 5. Assisted living facilities 6. Baker Acts & mental health services 7. Durable medical equipment & oxygen 8. HIV/AIDS services 9. Homeless assistance 10. Home health care 11. Home IV infusion & IV antibiotics 12. Hospice/palliative care 13. Meal services and community nutrition resource services 14. Pediatric services 15. Prescriptions: medications, TB, & seizure meds 16. Primary health clinics/ambulatory 17. Private homemaker/companions; nurse’s aides 18. Senior services 19. Skilled nursing facility placement 20. Social service agencies 21. Substance abuse; Marchman Act 22. Transportation, miscellaneous (hurricane, toll-free hotlines, hotels/motels, Broward County Public Health Dept.) 23. Reportable diseases, dental and optometry care 24. Veteran’s services 25. Out-of-area (county transfers) services for uncompensated patients Comments:
November/December 2006
TCM 67
66-68_YMCM420_Sands_CP.qxd
11/8/06
2:41 PM
Page 68
Figure 2 NBMC’S CASE
MANAGEMENT DISCHARGE PLANNING MANUAL IS
ONLINE AND AVAILABLE TO ALL!
This manual is now available on the intranet under the Document Library tab. Visit this tab to locate the manual. • Click on the drill-down menu (+) next to the Discharge Planning folder. • You can view 25 folders organized in alphabetical order. A series of PDF documents are contained in each of these folders. You may print any or all of these documents to use as a resource. If you have any questions or comments, please contact the case management team at ext. 6733. •
maintaining the manuals and their causes. They decided to convert the manual into an electronic format and publish it on the North Broward Hospital District’s intranet, thus extending its accessibility and availability. The subgroup in charge of the manual’s transformation determined that the categories of the paper manual were still relevant and several new sections were needed. A review sheet (Figure 1) was developed and used with each section of the manual to document the review status and progress of the specific section. Current paper-based resources were reviewed to identify items that were still current and should be included, along with a list of resources to be added and the need to search for new resources. Each team member was responsible for designated sections of the manual. A summer intern had the responsibility to type items that were not in electronic format, update and revise those items that were in electronic format, verify that resources entered were current with correct contact information, and perform the research to identify additional resources. Once the information was obtained, the intern collated the information, scanned forms so that they would be available in electronic format, and placed items in the prescribed order by section. The completed electronic manual was forwarded to the CM information services (IS) liaison; she had the manual uploaded to the intranet within days. Education about the manual’s availability and accessibility, including the “how-touse” instructions (Figure 2), was provided in various forms, including placing TCM 68
November/December 2006
announcements about the manual’s availability on the district’s home page; CM departments at sister facilities were alerted to its availability; all district department managers were provided with information in the monthly IS publication distributed at the monthly organizational staff meeting; and CM staff provided hands-on demonstrations to nursing staff. Satisfaction surveys have indicated that employees beyond the CM department are regular users of the resources; in addition, select resources are printed for patients and families. Employees report that they have used the manual to locate resource information for family or personal problems without needing a coworker. Staff in the emergency department and clinics report being able to rapidly provide community resources without having to wait for social work staff, reducing wait times and increasing customer satisfaction. The CM staff was so excited about the transformed resources that they featured it at the hospital’s annual Quality Expo competition, and the project was selected to be a presentation at the South Florida Chapter of the American Society for Quality’s 16th Annual Performance Excellence Showcase. ❑ Judith R. Sands, RN, BSN, LHRM, CPHQ, CCM, ARM, CLC, is the regional manager for case management at North Broward Medical Center in Deerfield Beach, Florida. Reprint orders: E-mail authorsupport@ elsevier.com or phone (toll-free) 888-834-7287; reprint no. YMCM 420 doi:10.1016/j.casemgr.2006.06.009