How 3 health systems are handling discharges during the pandemic

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The COVID-19 pandemic has forced healthcare leaders nationwide to rethink how their organizations approach safe discharges, as virus-related visitor restrictions mean many family members cannot be at the patient's bedside to hear discharge instructions.

The pandemic is also placing great demand on hospitals' bed capacity, further underscoring the need for efficient discharge processes.

Becker's recently connected with leaders from three health systems to understand how they are handling discharges during the pandemic. Four key strategies emerged from these conversations, summarized below.

1. Technology. Many health systems have adopted or expanded virtual video capabilities for discharge planning purposes.

"We leveraged technology early on in the pandemic to support patients during that transition," Mary Noli Pilkington, RN, BSN, care coordination systems director at Los Angeles-based UCLA Health, told Becker's.

Every patient receives an iPad equipped with Zoom capabilities upon admission. Case managers can then schedule a Zoom call with the patient, his or her family members and any post-acute care providers, if necessary, to discuss discharge planning well ahead of the patient's discharge. Written discharge instructions and any relevant COVID-19 care information are also automatically uploaded to the patient's after-visit summary and MyChart records, in case the patient forgets verbal instructions or needs additional clarity.

"So not only do we have a discussion via Zoom, but we reinforce all the education through documentation that's available to patients as they go home," Ms. Pilkington said, adding that patients have responded very positively to the technology.

The iPads are also equipped with informational videos about UCLA Health's skilled nursing facility partners to help patients decide which they'd like to go after they're discharged. Patients and families can set up a Zoom session with the facility to learn more and ask direct questions. Ms. Pilkington said UCLA Health plans to keep this process in place even after the pandemic ends, as it is far more effective and efficient than having family members physically visit each skilled nursing facility while the patient is still hospitalized.  

2. Exceptions to visitor restrictions. Like many health systems, San Francisco-based UCSF Health has made exceptions to visitor restrictions for patients and family members who would benefit from in-person discharge planning. 

Molly Shane, RN, director of care management and patient transitions, said the health system strongly encourages the use of virtual visits and offers patients access to a virtual visit navigator who sets them up with the appropriate equipment to connect with their loved ones. 

"However, in order to ensure safe transitions in care, especially at the time of discharge, patients and family members who would benefit from face-to-face caregiving instructions are approved as an exception to help support and facilitate this transition," Ms. Shane told Becker's

3. Increased collaboration and communication. To ensure safe, efficient discharge planning during the pandemic, many health systems have doubled down on communication and collaboration efforts across not only their own teams, but with patients, family members and post-acute partners.

Three clinical leaders at Los Angeles-based Cedars-Sinai Medical Center said their discharge process has evolved since the pandemic started to place a greater emphasis on patient and family communication. 

"Our case managers, physicians and nurses are spending a lot more time on the phone or over video chat with our patients' loved ones to make sure that they completely understand discharge instructions before a patient leaves the hospital," Bradley Rosen, MD, vice president of physician alignment and care transitions; Eunice Ninet, RN, case manager supervisor of the inpatient specialty program hospitalist service; and Todd Griner, DNP, RN, executive director of critical care services, said in a written response to Becker's.

At UCLA Health, clinical and case management leaders worked with IT colleagues to quickly equip every room with an iPad when the pandemic hit. Ms. Pilkington credited the teams' well-established working relationship as a key part of the effort's success. 

"A lot of times you'll think of a creative solution and it takes you time to move to adoption. But if you know who can help you right away, it makes it much more efficient," Ms. Pilkington said. 

UCLA Health also ramped up communications with its skilled nursing facilities and home health agencies during the pandemic. Previously, leaders met with these providers monthly as part of an existing transition of care collaborative. This spring, the health system transitioned to weekly Zoom meetings, which offered a platform to communicate about patient volume, get briefed by local health officials and answer post-acute care providers' questions about personal protective equipment or infection control best practices. The sessions also allowed UCLA Health to teach post-acute partners how to use Zoom for future discharge planning meetings with patients. 

4. Safely expediting discharges. Cedars-Sinai recently implemented a program to expedite the discharge of clinically stable patients who may or may not have COVID-19.

The Safe Transitions and Reassurance, or STAR, program allows eligible patients to finish their treatments, such as supplemental oxygen or IV medications at home, instead of in the hospital.

"The STAR program allows patients to continue recuperating in the comfort and safety of a familiar environment, where they can be with loved ones while freeing up hospital resources for those patients who need them most," Dr. Rosen, Dr. Griner and Ms. Ninet said. 

Cedars-Sinai's ambulatory case management team works with the patient's community physician to monitor the patient and follow up as needed.

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