Submitted by Charles Bell on March 2, 2023 - 3:46pm
Last revised by Brian Holt on March 16, 2023 - 1:24pm.
Proposal Status:
- PROPOSAL TITLE: Improvement of Interoperability with pre-assessment screening of planned surgical candidates within the UCSF system
- PROJECT LEAD(S): To be determined
- EXECUTIVE SPONSOR(S): Case management department
- ABSTRACT - As per diem case manager servicing the Mount Zion ortho campus, I, Charles Bell have found a common occurrence of patients admitted for planned procedures without adequate pre-operative screening or the communication of the results. The standard of care for all planned surgeries is for a pre-operative screening to occur with details such as support post-operatively, financial concerns (including insurance), transportation for post-discharge, and if indicated, discussions about options for home health, SNF, or acute rehab facilities. My experience is that documentation or discussion of mentioned standards is not addressed in the pre-operative screening or if it does the information is not available for the inpatient case manager to view. This lack of information collected or inability to view causes tremendous barriers to discharge planning, frustration with patients and families, burnout of inpatient case managers due to increased workload, increased length of stay, denial from insurance companies due to lack of medical necessity for continued stay, delay in appropriate treatment of patients and ultimately loss in revenue for the UCSF system.
- TEAM - Team members for the project would include the case management department both inpatient and outpatient. Pre-screening individuals in the surgeon's office, physical and occupational therapist. Informatics department
- PROBLEM - The problem is the failure to create interoperability between systems at UCSF to allow for inpatient, outpatient teams, and the surgeon's offices to communicate effectively. I would imagine the cost of this problem to be tremendous. Maybe to be in the millions of dollars on a yearly basis. I believe that addressing poor utilization of resources to maximize revenue is always something to be looked into for the betterment of the system.
- TARGET - To create interoperability with the use of existing technologies for the betterment of patient outcomes and overall job satisfaction of employees. I firmly believe that with a little effort, revenue can be maximized and patient outcomes and staff job satisfaction can improve dramatically
- GAPS - A problem exists due to the lack of interoperability between existing technologies. I believe that creating simple lines of communication with outpatient, inpatient case management, and surgeon's offices would help to reduce gaps
- INTERVENTION - My intervention plan would be to create a workflow improving lines of communication between the surgeon's office, and outpatient and inpatient services. This could be through the use of digital technologies such as Voalte or through the EPIC assessment tab. In other words, information could be passed to the inpatient case managers once the prescreening of patients has occurred allowing for better planning. This would include a population of planned surgeries for all campuses at UCSF. Barriers to implementation would be buy-in from the staff potentially as initially, this would involve a change in workflow. However, I believe that ultimately it would improve the work environment tremendously. I do not anticipate any negative outcomes for patients from this proposal
- PROPOSED EHR MODIFICATIONS Note: I believe that UCSF has the technology in place to facilitate the transfer of this information between interdisciplinary team members. i just believe that it is not being utilized. I believe the problems solved here will be happier staff and patients due to a decrease in stress levels from better planning. In addition, research has shown that the increased length of staff for inpatient status increases the risk of nosocomial infections.
- Why does the problem exist? Poor utilization of resources
- Describe system issues; technological gaps; educational gaps with APeX? I believe that lack of education about good discharge planning is part of the issue. Once practitioners understand the dynamics of great case management then they will see improvements in the workflow through the utilization of technology
- COST - I believe the financial gain from improvements would be tremendous. Surgical services are the highest income for hospital systems and any improvement in workflow would show tremendous gains. I do not believe the financial cost of implementation would be costly. This is a problem that I believe could be solved without complex interventions. UCSF has the existing staff and technology in place.
- SUSTAINABILITY - I do not believe further funding would be necessary as key players in implementation are already in the plan
- BUDGET - Line-item budget up to $50,000 - There could be the potential for adjustment in digital technology systems such as Voalte or other EPIC adjustments.