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.