The Science Journal of the American Association for Respiratory Care

2004 OPEN FORUM Abstracts

REFINING RESPIRATORY CARE’S PROCESS FOR HANDLING DME ARRANGEMENT AS AN EFFORT TO IMPROVE THE CONTINUUM OF CARE

Anna Mikhalsky RRT, RCP, Jan Phillips-Clar RRT, RCP, Richard Ford RRT, RCP, Timothy Morris MD UCSD Medical Center San Diego, California

OBJECTIVE: Arranging inpatient durable medical equipment (DME) services have always been an accepted level of responsibility for the respiratory care department without a designated full time employee. No type of structure or guideline had ever existed for this particular service. On many occasions both the nurse case managers and respiratory care staff have been called separately to make DME arrangements. No mechanism had ever been put in place to designate if either the nurse case manager or the RCP should be called when patients discharge orders were written for respiratory services. With lack of communication between the two services, there were times in which both disciplines were determining insurance qualification, and even contacting different companies for the same services. This caused delayed discharge times and ineffective utilization of multidisciplinary personnel’s time.

METHOD
: In a baseline survey, we asked nurse case managers and respiratory care staff if they were satisfied with the current DME discharge arrangement process and the time it required for completion; 100% were not satisfied. We then met with the director of resource management to identify problems within current practices. We defined roles and collaborated ordering processes between respiratory care and nurse case managers. We clarified the RCP’s role with departments who were requesting outpatient services. Based on our collective data, a form was developed to document the patient’s discharge assessment and determine their respiratory care needs. A DME reference manual was created which directed RCPs through the home care referral process. Included in this manual were step-by-step algorithms for all respiratory modalities that could be obtained through DME companies and quick reference guides of our available insurance and DME companies. We joined the resource management distribution list in order to be updated on changes within their department. To comply with the Medical Center’s efforts for multidisciplinary charting, we began charting all DME activity in the Patient Care Plan.

RESULTS
: The RC team leader completes the DME assessment sheet for all patients ordered for Respiratory Care Services, and then a copy is faxed to the nurse case manager. Nurse case managers will order DME equipment, with the exception of ventilators, on all patients with HMO/PPO insurance. The RT department will take care of other patient populations. In some instances, if the patient is non-HMO/PPO, the nurse case manager will order respiratory equipment along with other medical supplies, to prevent two different companies from being called. After implementation of this new process, including the assessment sheet and DME reference manual, our follow up survey showed 100% satisfaction. The average set up time decreased by 1.5 hours.

CONCLUSIONS
: The new DME system has allowed the RC department and nurse case managers to expedite the discharge time for all patients ordered on DME equipment. We minimized duplication of efforts and as a result, we have improved the continuum of care.

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