Quality teams had to manage the push and pull of maximizing the discharge process to create bed space while ensuring patients returned home with everything they needed to prevent them from find themselves in one of these beds.
Allegheny revamped reviews of social determinants risk profiles for patients without COVID-19 before discharge. The health system took into account factors at home that could create a higher risk of readmission, such as access to transportation and food insecurity. Patients were also connected with nurses two days after discharge instead of the usual seven days.
ChristianaCare, a two-hospital system based in Wilmington, Delaware, already had experience with throughput issues related to stroke patients before the pandemic. When it became clear that their standard admission criteria would cause delays in care due to bed capacity, the nonprofit turned to the telemedicine system already in use for its stroke program.
Some patients who would have been admitted before have gone home instead. ChristianaCare connects them with remote nurses and other caregivers who supervise them through in-home equipment provided by the hospital. The healthcare system has not seen any bumps in readmissions, post-surgical complications or infections, said chief medical officer Dr Kert Anzilotti.
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“It was a real quality and safety challenge, because we had to make sure that they had their rehab, that they got their physiotherapy, that they were going to do all these steps that they would have done as hospitalized patient to rehab,” Anzilotti said. . “We really had no choice during COVID-19 but to do things differently and innovate.”
The discharge period is generally the riskiest for patients, as they move from a highly controlled environment to homes or other environments without equivalent supervision. Realizing this, UPMC’s Burwell got involved.