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Learning Objective 1: describe the nurse case manager's role in Clinical High Risk meetings.
Learning Objective 2: describe the effect of Clinical High Risk meetings on patient length of stay.
BACKGROUND: Discharge delays for medically stable patients negatively impact hospital cost (Freitas, 2012; Srivastava, 2009), throughput (Costa, 2012), and patient morbidity (Cortoos, 2012). Acute care hospitals are increasingly focused on strategies to reduce delays and length of stay; research suggests that collaborative discharge planning is one solution (MacKenzie, 2012).
METHODS: Clinical High Risk (CHR) meetings were implemented in March 2012 to proactively identify and address patients' potential and actual barriers to discharge. High risk patients are defined by patients who meet or exceed 150% of the average length of stay (ALOS) by admitting service or those who clinicians identify as being clinically complex, unfunded, undocumented, or lacking social support. CHR meeting participants include staff and leadership from the nurse case management and social work departments. Each patient is discussed in SBAR format: Situation, Background, Assessment, and Recommendation. After identifying potential solutions, nurses and social workers confer with the interdisciplinary team to implement the solutions identified during CHR meetings.
RESULTS: The number of identified high risk patients has declined by 4.6% between the time of CHR implementation and January 2013. In correlation, there has been a reduction in long length of stay (LOS) patients for the same time period: 27.6% decline in LOS > 30-59 days and 24% decline in LOS > 60 days.