Discharge resource centers on the upswing
Learning objective
At the completion of this educational activity, the learner will be able to:
- Discuss the advantages of using a centralized postacute resource center to carry out discharge plans.
Discharge planning has become more important in recent years. Not only is the government putting new focus on ensuring hospitals are helping patients to move to the next level of care more efficiently (see related story on p. 3), but research shows that patients are safer and less likely to return to the hospital if these transitions are well managed.
However, ensuring that discharge plans are carried out efficiently and effectively has been a challenge for many organizations. Enter the postacute resource center (PARC)?a new department many hospitals are adding, which is specifically tasked with ensuring a smooth transition to postacute follow-up.
"I encountered the concept of a ‘resource center’ back in 1997 in a Connecticut hospital," says Stefani Daniels, RN, MSNA, CMAC, ACM, president and managing partner of Phoenix Medical Management, Inc., in Pompano Beach, Florida. The concept was working so well at this hospital the leadership team asked that it not be disturbed during their case management redesign, she says. "Since then, I’ve been a huge proponent of having a centralized PARC since I’ve seen firsthand what a value-added service it provides to the entire hospital community."
There are many ways to structure a PARC, but Daniels advocates for using a centralized model, one group that is tasked with facilitating the logistics necessary to carry out discharge plans, because it is the most efficient. In this model the PARC isn’t involved in the discharge planning process?that requires professional assessment?but the PARC team ensures that the plan is carried out.
"Once the process of referring discharge plans prepared by the patient’s nurse or a care manager to the PARC for facilitation is tested and reinforced, the scope of the PARC’s service can be broadened to include other community-based services, such as arranging and follow-up of postacute primary care or clinic appointments," she says. PARCs can also be marketed to community-based physicians to arrange immediate home care services to avoid an emergency department (ED) visit or direct admission. Organizations can also use PARCs as the coordinating arm of an active transitional care program when inpatients are identified as potential candidates for short-term transitional care, says Daniels.
The model in practice
Daniels recently helped ProMedica Monroe Regional Hospital in Michigan add a PARC during a larger case management department revamp. Gary Moorman, DO, vice president of medical affairs at ProMedica Monroe Regional Hospital says the hospital’s PARC acts as a hub, a central location where clinical care coordinators and physicians are able to hand off the plan they develop to individuals whose job it is to ensure it is carried out properly.
The discharge hub handles referrals, arrangements for extended care, and helps schedule follow-up physician appointments and home healthcare, says Moorman.
Clinical care coordinators along with physicians develop the discharge plans and then hand them off to the discharge hub, which is staffed by a mix of social workers and support staff.
Not only has this initiative saved money by freeing clinical staff members from the logistical aspects of discharge planning follow-up, but it has also given social workers at the organization, who were formerly in charge of these discharge planning duties, more time to focus on their real job, social work, says Moorman.
Having staff members designated for discharge follow-up helps to ensure that discharge planning tasks don’t fall through the cracks and that there is a central contact for follow-up.
"The discharge process is more coordinated, and potentially safer and more efficient," says Moorman.
He says the organization hopes the PARC will also bring the added benefit of reducing readmissions among its high-risk patients by keeping in closer contact with those individuals and helping to improve the likelihood that they will comply with follow-up care recommendations by helping them schedule their follow-up appointments.
"I think the patients generally are overall satisfied," he says. The nurses on the floor have also been happy with the effort because they’re seeing an improvement in communication.
A changing regulatory landscape
Using a PARC may become increasingly advantageous in coming years, in particular if expected changes to CMS’ Conditions of Participation for discharge planning go into effect, says Daniels. "It is expected that discharge planning, a core competency of the professional nurse, will be restored to the patient’s nurse who will once again be responsible for collaborating with the care team to establish a discharge plan for patients who are not assigned to a care manager and who typically have routine discharges to home or home with home care or DME or return to SNF," she says. "Having a PARC to facilitate that plan will be essential. Similarly, as care managers working in a fee-for-value environment are expected to monitor progression of care for selected patients more assertively, they too will benefit from having a PARC work its magic."
Organizations looking to add a PARC should recognize that this is only one component of the overall case management department and might not have worked as well if other changes hadn’t been made to support the effort, says Moorman. At their organization this larger redesign also included better defining special functions for case managers, UR, and social work to ensure the process was as efficient as possible. "You probably want to look at the whole process, not just the discharge piece of it," says Moorman. But having a new hub for discharge duties has definitely helped to make patient transitions more efficient.
