Improving the VA patient journey with data transparency
- By David LaBorde
- Nov 16, 2018
Care coordination lapses are hampering the delivery of care to patients all over the country. Many of us have experienced this firsthand -- procedures cancelled at the last minute or delays even when all paperwork is in order. Beyond the frustration to the patient and family members, these inefficiencies can have a domino effect on patient flow. When a facility is running at capacity, delays in one patient’s care can cause bottlenecks and tie up resources that otherwise could be used to care for another patient.
Such preventable delays that impact patient flow happen at all the waystations of the patient journey -- admissions, transfers, discharges, procedure suites. To illustrate, let’s zero in on the patient discharge process -- a common bottleneck faced by many hospitals. Too often discharge orders that could have been written early in the morning are written later in the day simply due to patterns in doctors’ rounds. Even when a physician has written a discharge order and the patient is medically cleared to leave, a patient can sit and wait hours for discharge. When the facility is capacity constrained, these delays can clog the emergency room, the post-operative care unit (and operating room) and intensive care units.
The failure to efficiently manage the input and output of patients in a methodical manner not only frustrates patients and delays care, but also negatively affects facility quality and outcomes measures.
For example, such delays can adversely impact a VA Medical Center’s Strategic Analytics for Improvement and Learning metrics that are used to assess the quality of care at each Department of Veterans Affairs facility. Some of the SAIL metrics impacted by patient flow delays include length of stay, readmission rate, acute care mortality rate, patient satisfaction, wait times and nursing staff turnover. Health care organizations need a software-driven solution, based on industry best practices, that provides actionable insights, predictions and data transparency around each stage of the patient journey.
This would allow facilities to measure and track the percent of discharges written before 11 am and the time between when the discharge order is written and when the patient actually leaves. Routinely measuring, monitoring and disseminating this information, in real time, along with the desired level of performance, helps facilities quickly identify problems that may warrant intervention and communicates expectations to staff.
New orders anywhere in the facility can be immediately communicated to key stakeholders, and any order that has not been fulfilled within 45 minutes, for example, can be escalated. Over time, facilities that pursue change management initiatives powered by such systems with the support of senior leadership can achieve sustainable change.
Furthermore, marrying such solutions with machine learning and artificial intelligence can further help facilities predict which patients are likely to face discharge issues, permitting earlier intervention and planning that can eliminate avoidable delays.
These tools are required to succeed in the era of value-based care and can have an immediate impact on patient flow leading to improved patient access, better capacity utilization, shortened lengths of stay, decreased ED wait times, fewer elective surgery cancellations, improved patient experience/satisfaction and more efficient care overall. All without adding additional resources or capacity to the system!
Here are the kind of results this better approach can deliver. Reducing discharge delay by just 30 minutes can save a facility an average of five hours a day. Over one year, that’s an additional 76 days, freeing up resources for almost 17 additional admissions while improving the patient experience. Over three years, that can amount to $1 million in additional revenue, simply by becoming more efficient. And that analysis does not include the many other upstream benefits to reducing discharge delays that lead to further opportunities to drive additional throughput, revenue and improved patient satisfaction.
The patient care challenge presented by millions of aging veterans and baby boomers requires the use of such software-driven solutions. Severely stretched medical personnel need this kind of actionable transparent data to deliver the best possible care. It can improve veterans’ care and significantly eliminate waste.
There are proven alternatives, and as a nation with an obligation to efficiently deliver health care to veterans, we simply cannot afford these inefficiencies any longer.
David LaBorde, M.D., is CEO of Iconic Data Inc. and strategic advisor with DSS Inc.