The Problem: Increased Length of Stay Due to Turnover

Two Florida partner hospitals have been hit hard over the last two years with COVID surges and high staff turnover resulting in an increase in length of stay (LOS). In order to rectify the LOS increase, it was determined that an increase in communication and a need for an HNI liaison to help bridge the gap between the acute and post-acute setting was needed. The quality performance specialist role was developed to do just that.

The Solution: Develop the Quality Performance Specialist Role

The quality performance specialist was developed to be a hybrid role: part case manager and part physician liaison.

The role requires: 

• Daily integration with the hospital case management team through team huddles to work through discharge barriers
• Rounding with a "boots on the ground” approach
• Strong relationships not only in the hospital but with post-acute liaisons and HHC agencies

Additional duties also include, but are not limited to: completing Medicare and Medicaid applications resulting in placement and checking insurance benefits, authorizations, and status of admission to SNF/HHC/Infusion. 

Results

Within one month of launching the quality performance specialist role, the LOS/GMLOS variance went from 0.19 to 0.00 at Hospital A and from 0.42 to 0.24 at Hospital B. This was maintained through a COVID surge which resulted in Hospital B being at 200% capacity with COVID-19 patients.

After the COVID surge, the quality performance specialist was able to directly work with the hospital case management department and patients at Hospital B to recover the LOS in the following months to a healthier variance of 0.16. This LOS recovery would not have been possible without the introduction of the quality performance specialist role. 

Since the role was introduced, the quality performance specialist has directly impacted positive outcomes for over 900 patients.

The Value of a Quality Performance Specialist in Action

The success of the quality performance specialist role is profound and has enabled our team to improve care transitions dramatically. Below is a story from our quality performance specialist in Florida describing how she helped a recent patient.

"Dr. Jo had a patient admit himself to the hospital and requested a Baker Act. He was not suicidal, homicidal, or in emotional distress. However, he needed psych meds and had a history of psych. Turns out he had been in a group home and DCF was involved.  DCF stated the patient could not return to his group home and reminded us they do not assist in discharge planning or placement. They advised case management that if the patient was discharged and anything happened, the hospital would be liable. We had no insurance on file for him and no contact information.

We did not know what to do with him.

First, I checked to see if he had Medicare since he had a psych diagnosis — which he did.

In doing that I was able to pull the address off of his Medicare eligibility and I googled it — Lutheran Services. So I call them and they did have him in their system and said he had been at Macclenny State Hospital prior. However, they could not provide services to him because he was incarcerated.

I called Macclenny State hospital and they confirmed the patient was discharged to jail in Duval County. I checked the Duval County website and he was last arrested in April 2021 for trespassing and sent to an IP psych. I asked Dr. Jo to discuss this with the psych physician — which he did.

I then called the DCF worker and LM and told them that this patient has the capacity to make decisions and we would not be holding him at the hospital. The Baker's Act was lifted so he did not meet the criteria for IP psych and he had no need to qualify for SNF. Plus, with his record, placement was not foreseeable. We would be discharging him to a shelter. The caseworker called back this morning and said they agree to the discharge. 

I do believe if I wouldn't have gotten involved, we probably would have held this patient for several days trying to determine what to do with him — and all on a social admission."

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