Inpatient admissions are declining in many of the rural and community hospitals we work with. When we take a closer look at their inpatient census, and ask questions about how they determine who to admit and who to transfer, we commonly find most hospitals don’t have formal guidelines to help determine which patients should be admitted and which patients they should transfer. Staff competencies, provider availability, and ancillary services provided often dictate a hospital’s ability to care for certain populations of patients or acuity levels.
But it’s important for your hospital to have a clear understanding of:
Who can be cared for at your facility, based on routine diagnoses and clinical indications for admission (acute and observation)
Who can’t be appropriately cared for at your facility (for example, patients who need higher levels of care such as; mechanical ventilators or invasive monitoring)
Why Is a Care Delivery Spectrum Important?
Admission rates vary across different markets in the U.S. While they have been declining overall in many parts of the country, some markets have seen increased admissions due to the COVID-19 pandemic, particularly in the emergency department. As a benchmark, we generally recommend that rural and community hospitals target 10% of ED visits as acute or observation status.
Defining a clinical care delivery spectrum helps your hospital be intentional about the patients you admit and transfer. This is crucial for several reasons:
Rural and community hospital closures continue to climb: Continuing to support inpatient utilization is an important factor in mitigating the risk of closure and other challenges, such as staffing recruitment, hiring, and retention.
Improved procedures and workflows create greater efficiencies: When the admissions process is well-defined, it is more streamlined and effective.
A care delivery spectrum decreases variation in clinical decision-making: With clear guidelines about which patients to keep and which to transfer, there is less variability for staff and providers to manage.
Patient satisfaction increases: If patients can receive the care they need in their local community, without having to travel, overall patient satisfaction is likely to improve.
Inpatient revenue has potential to grow: With increased admissions through inpatient units, hospitals have greater opportunities to improve revenue.
Key Metrics for Improvement
As you develop a care delivery spectrum, focus on targeting the right areas to measure, track, and improve to boost efficiency, including:
Patient throughput (timelines in the ED, inpatient admission process)
Increased admissions (with a target of 10% of ED visits)
Decreased transfers (with a target of less than 6% of ED visits)
Streamlined process (identifying and reducing inefficiencies, incorporating telehealth)
Reducing costs and opportunity costs
Improved value (delivering patient care services in the most appropriate care setting, receiving payment for services rendered)
Key Steps to Develop a Clinical Care Delivery Spectrum
Gather and review pertinent current clinical and utilization data.
Start with baseline data to understand where you are right now. For instance, are you seeing transfers increasing and admissions declining?
Conduct a gap analysis.
Understand your starting point for clinical care, such as the specialty services you currently offer and the equipment you have to support patient needs. What else do you need? Where are the gaps you need to fill?
Conduct interviews with key team members.
Talk to key team members in your organization about the barriers that exist. What is standing in your way? How do you plan to minimize these barriers to better support the needs of your organization?
As a team, audit transfer charts.
Analyze your transfers, and determine the top five to 10 reasons for transferring patients. Are there patients you’re transferring that you could be admitting? What are the missed opportunities?
Determine what could have been done to keep potentially avoidable transfers.
Ask questions, such as: Do we have this service? Do we utilize this service? Dig deeper into potentially avoidable transfers, sending them to your interdisciplinary team for review. What does this data tell you about your transfer process? Use this information to begin crafting your care delivery spectrum based on yes, maybe, and no categories.
To learn more about how our clinical and quality team can help your hospital with its Clinical Care Delivery Spectrum, connect with our team.