Accelerate Throughput by Optimizing Discharge Planning & Post-Acute Placement Across Care Settings: Part 1

By Gina Kidder, MSN, ACM-RN, Client Outcomes Engineer, ABOUT 

Health systems are facing pervasive challenges in discharge planning and post-acute placement across the nation. Look no further than recent headlines across the healthcare media: 

• Ready to be discharged, Minnesota hospital patients have nowhere to go 
• Emergency room, inpatient boarding racks of exorbitant costs for hospitals, report shows 

• Transitions to post-acute care are getting even more challenging 

While these all illustrate the patient and economic impact, there’s also a less obvious effect on front-line workers. As a care manager myself, I understand the feeling when your patients don’t discharge—you feel like your efforts weren’t enough and you’re failing your patients. 

In this article we want to share some practical best practices and solutions we’ve learned through working with over 100 of the leading health systems in the US to put you back in the driver seat in accelerating throughput.  

Identify the Challenges

The Average Length of Stay (ALOS) has gone up by 24% in the last three years for patients needing post-acute care services after inpatient care. It’s important to first understand the root causal factors that are creating the increase in ALOS to then identify what is within your control to reduce bottlenecks to throughput and capacity.  

Macro, External Causes 

• An aging population with more prevalent chronic illnesses creating an increasing number of patients discharged to post-acute care.  
• Rise in Medicare Advantage Plans which require prior authorization to be placed in a Skilled Nursing Facility. 
• COVID-19 causing delays to discharge. 
• Staffing shortages within post-acute care. 

Micro, Internal Causes  

• Discharge planning and post-acute placement process inefficiencies. 
• Slow prior authorization process completed by PAC facilities. 
• Staffing shortages within the health system and personnel not working at the top-of-license.  
• Transportation coordination inefficiencies.  

Readmissions can cost the health system up to $2,800 per avoidable day per patient. And we know avoidable days not only impact health system financials, they also affect patient safety and outcomes. In fact, a recent study showed that length of stay increases crude mortality rate from 21.4% if under six hours to 31.8% if over 24 hours.  

While the external factors are somewhat out of the health system’s control, there are steps you can take to decrease LOS and avoidable days through people, process, technology, and your network.  

Solutions 

People
Hiring the right staff and retention are the foundation of an efficient care management team. Here are some top care management staffing solutions to combat the current challenges: 

• Examine overall staffing model, leadership, and reporting structure – Ensure you have the right mix of clinical and non-clinical staff so that everyone is working top-of-license. 
• Assign resources based on needs and data – Analyze trends from across care settings and care management departments. 

• Hire the right skillset – Strong communication skills, high emotional intelligence, critical thinking skills, and the ability to think outside the box.  
• The right incentives – Offer signing and retention bonuses and look at ways to provide more flexibility to staff, such as hybrid or job-sharing models.   

Stay tuned for part two of the blog post next week where my colleague Jen Eriks will share process, technology and network solutions.  

In the meantime, learn more about standardizing post-acute placement across care settings by watching our recent PAC Coffee & Care Orchestration Webinar.