Improving Workflow

Simple Steps to Improving Workflow

Improving the Care Management Referral Process

A current workflow concern within the ambulatory care management department is the amount of time required for a care manager to complete a referral review, intake process, and necessary documentation, to only have the patient not consent to services.  Time is wasted tracking down providers to clarify the referral reason, which in turn delays care management intervention with the patient.  Time is also wasted sorting through reports utilizing predictive analysis for the same purpose, especially when chart review indicates an appropriate use of healthcare services. A focus on high-risk care management for patients who have complex medical needs complicates the selection process and introduces new challenges in providing comprehensive care coordination (Cohen, Flaks-Manov, Low, Balicer, Shadmi, 2015).  Nurse Care Management staff have expressed that their time is better spent on direct patient contact and care planning with high-risk patients, rather than reviewing charts or reports, to determine if criteria are met, including making multiple attempts to contact and enroll patients.  

To address these concerns the ambulatory care management department has instituted a clinical intake referral nurse whose prime function is to sort through referrals, complete a chart review, gain patient consent, complete the initial assessment, and assign appropriate staff.  This process involves enhancement to the current EHR, which includes the development of an electronic care management referral work queue.  The use of electronic systems to inform the structure and function of the referral process maximizes the level of care coordination (Tuot, Murphy, McCullough, Leeds, Chan, & Chen, 2015). As with any referral, the CM referral is easily accessible at the point of care.  Simple checkboxes consistent with care management inclusion criteria constitute the referral information. This eliminates provider confusion of having to remember selection criteria.  The submission process is streamlined, which reduces any interruption in referral delivery and improves process time, meaning patients receive an earlier intervention.  Implementation of a few key strategies makes a significant impact on the quality of the referral process, increases timely completion of referrals, and decreases the potential of undesired outcomes that may result from a delay in the workflow (Davidow, Sheth, Sixta, & Thomas-Hemak, 2018).

Once received in the care management work queue, the Clinical Intake R.N. Care Manager will work the referral to determine suitability based on chart review. She will then contact the patient to complete an initial assessment, which includes identifying barriers to care, as well as, obtaining patient consent for program participation.  The referral is then routed to the R.N. Care Manager so that patient-centered goals can be established and a care plan created.  Communication back to the ordering provider is completed through a direct link with the patient’s EHR and is also documented directly on the referral thus eliminating additional time spent scrolling through notes for patient status updates and closing the referral process loop.  Having a single R.N. care manager control the referral queue provides consistent documentation and removes any variation throughout the process leading to improved reliability.

The literature suggests that determining the most appropriate patients to participate in care intervention programs is of increasing priority to care coordinators and is most beneficial when completed through an integrated approach (Cohen et al., 2015).  Many benefits are realized as a result of enhancing current technology to enrich the current workflow process. Increased productivity, decreased provider confusion, increased workflow efficiency, improved communication, and timely patient engagement are included, among others.  Improving upon and building a robust referral management process assists the primary care provider with improved care coordination that contributes to achieving the quadruple aim of health care (Davidow et al., 2018). 

 For More Information on Improving Care Management Workflow

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Reflection 

This exercise has caused me to consider other workflows in my current role and how technology can aid in their improvement.  Even something as simple as a chart review can be improved upon by streamlining EHR records and creating a patient dashboard which displays pertinent categories of information with links to specific information embedded under each item.  The chart review process can be a long, tedious, and frustrating process. A patient dashboard would cut down on time spent "scrolling" through the medical record to locate information providing nursing with more time to do what we do best, care for our patients. Technology in nursing is improving the way care is provided, and as nurses we should harness our clinical expertise to assist with this process. Competencies in technology and informatics are central to the success of  future nurses, as well as, growing the profession.

References

Cohen, C.J., Flaks-Manov, N., Low, M., Balicer, R.D., & Shadmi, E. (2015). High-risk case identification for use in comprehensive care management. Population Health Management, 18(1), 15-22. Doi: 10.1089/pop.2014.0011

Davidow, S.L., Sheth, J., Sixta, C.S., & Thomas-Hemak, L. (2018). Closing the referral loop: Improving ambulatory referral management, electronic health record connectivity, and care coordination processes. Journal of Ambulatory Care Management, 41(1), 240-249.

Tuot, D.S., Murphy, E.J., McCullough, C.E., Leeds, K., Chan, E., & Chen, A.H. (2015). Leveraging an electronic referral system to build a medical neighborhood. Healthcare, 3(4), 202-208. Doi: 10.1016/j.hjdsi.2015.014.001