Optimization of Patient Progression in a New Era: A Comprehensive Framework

Area of Science:

• Healthcare Management
• Health Services Research
• Hospital Operations

Background:

• The COVID-19 pandemic exacerbated hospital capacity crises and staffing shortages, increasing demand for inpatient services.
• Delayed patient throughput and prolonged lengths of stay became critical issues in acute and post-acute care settings.
• Novel strategies are essential to efficiently move patients to lower care levels when medically ready.

Purpose of the Study:

• To develop and implement a strategic framework for patient progression to improve efficiency and resource utilization.
• To capture patient progression data and optimize the use of post-acute care resources.
• To address capacity challenges in complex and resource-constrained healthcare environments.

Main Methods:

• Implemented interventions within a strategic framework to test new care models for patient progression.
• Utilized a modified early screening tool for discharge planning to prioritize case management.
• Employed interdisciplinary care optimization rounds and an electronic health record tool for communication and barrier identification.
• Managed high-risk patients with a dedicated complex care team and developed specialized pathways for transportation and hospice.
• Established community hospital repatriation and a 'Why Not Home' campaign for physical therapy.

Main Results:

• A modified discharge planning tool screened out 53% of low-risk patients, reducing length of stay by 0.55 days (p = .083).
• Documentation adherence exceeded 98% postimplementation.
• A complex care team reduced Case Mix Index-adjusted length of stay by 2.5%.
• A care van offset traditional transport in 10% of cases, enabling earlier discharge in 21% of cases.
• Community repatriation pilot reduced discharge delay days by 1,000 over 10 months for 40 patients.

Conclusions:

• Implementation of the novel patient progression framework improved operational efficiency and positively impacted length of stay.
• Innovative approaches in case management, as demonstrated by the Brigham framework, can address care transition challenges.
• Further research is needed to understand long-term benefits and fully mitigate evolving capacity challenges.