The United Hospital Fund is a nonprofit that is embarking on an important initiative. Their Difficult Decisions series explores the challenges that hospital staff personnel face in planning discharge.

The third in the series looks at the transition to post-acute care, usually to a Skilled Nursing Facility (SNF). And the study itself brought to light important insights for all providers, in understanding discharge planning, as well as patient transitions, more generally.

The most salient point in the study is, as Fierce Healthcare summarizes, that discharge planning presents profound obstacles for the hospital staff personnel who carry it out. Both administrators and staff very much have a goal of continuity of care. But the tools and structures that staff personnel encounter make the outcome of discharge planning fall short, many times. 

For any of us who work in hospitals every day, none of this comes as a surprise. That said, there were several nuances in the study that were enlightening in exploring when balls get dropped in discharge planning -- and how we might improve that process. 

Why Balls Get Dropped in Discharge to Skilled Nursing Facilities: 

1. Discharge plans are made without real input from the people carrying them out. 
   One thing that I loved about this study is that it was carried out by talking directly to the people who are actually doing the work, in order to understand the real challenges and opportunities they face. For that reason, I think the insights carry more weight than a study solely based on administrators, or findings from a think tank or conference. Similarly, discharge plans are sometimes coordinated "at the top" rather than allowing them to be shaped and reshaped by the medical team, across the continuum of care.
2. Discharge plans are often static. 
   The status of a particular patient changes quickly and often without warning, which means that the discharge plan must change and evolve, too. A static plan won’t work. And one that’s created once and then executed by members of the care team, in their offices or even across institutions won’t work. That’s why a tool like iClickCare -- which uses telemedicine to support medical collaboration for care coordination -- is so crucial. As the patient's situation changes, the entire care team can continue to influence the discharge plan, communicate about status changes, and get multiple perspectives.
3. There is little communication across institutions. 
   Although, in theory, a nurse at a Skilled Nursing Facility, or a doctor at a hospital can always "pick up the phone,"  the pace of medicine and the realities of scheduling makes telephone tag nearly impossible to do successfully. For that reason, there is often little communicate across institutions -- for instance, from a hospital to a Skilled Nursing Facility, or vice versa. That means that information is often fractured and things can get missed, not to mention that crucial nuances of patient care fall by the wayside altogether. 
4. Patients are given information, not guidance. 
   In theory, patients are given the information they need (for instance, a list of skilled nursing facilities). But realistically, they’re not being given the guidance or support necessary to make high-quality decisions about "next steps" in their care. True guidance and support means their whole care team working with the patient collaboratively -- throughout the duration of their illness.

In exploring the findings of this study, it was so clear to me that "trying harder" is not the answer when it comes to healthcare providers doing care coordination and discharge planning effectively. Teams need excellent tools and strong processes to support them in actually creating the continuity of care they intend to. And telemedicine-based medical collaboration is one of those crucial tools. 

You can try iClickCare today to support your organization in doing care coordination as effectively as it intends:

Recently, I’ve been coming across more data that solutions like iClickCare in an SNF or Long Term Care setting can be transformative. We know it from our colleagues that use iClickCare in these settings, but the studies are helpful in providing context and ROI.

For instance, this author at the University of Arizona says, "Telemedicine offers great promise as a strategy to reduce the skilled nursing/emergency department loop." And this study looks at the dramatic impact telemedicine can have on hospitalizations from SNFs and the cost savings that accompany this shift.

But we identify two key blind spots that these programs have -- which can have unintended negative consequences for the well-intended telemedicine programs.

In both articles, the author is assuming that telemedicine in the SNF context looks like a doctor virtually "seeing" a patient in an SNF, after hours. 

No doubt about it, these initiatives are being shown to have strong positive consequences for hospitalizations and costs. For instance, this study finds that "after the introduction of the telemedicine service, hospitalization rates declined 9.7 percent among the intervention facilities" and there resulted $120,000 in net cost savings.

On one hand, we applaud these SNFs for their use of telemedicine and for trying something new. But we see two big blind spots in this program -- so if you're considering a telehealth solution in your program, we encourage you to keep two considerations front-of-mind:

• Does it depend on busy providers always being available?
  One key problem with the telemedicine program described above is that it depends on the consulting provider being available at the time of the consult. During after-hour periods, this becomes increasingly difficult. We all know how challenging playing "phone tag" with other providers can be. Playing "video conference tag" is even worse. If you're implementing a telemedicine program at an SNF, we encourage you to look for a solution that is asynchronous, which allows providers to consult on their schedule.
  
  
• Does it improve or worsen care coordination?
  If a provider is giving a video-based consult after-hours, it's likely that the content of the consult will be difficult to integrate into the rest of the patient's care. Certainly, an additional provider can be available to document the findings in an EMR/EHR, but this requires yet more providers available at the time of the consult. That's why we believe that a telemedicine solution must facilitate the medical collaboration that needs to occur -- with one provider asking another for a consult, not a patient wrangling a doctor via FaceTime -- and that that consult must be saved and available for every other member of the medical team. In a context where the patient's issues are simple and not chronic, a one-off video consult could work well. But for the complex, often chronic issues found in most SNFs, we think that a hybrid store-and-forward telemedicine solution is the only adequate approach.

There is a really wide range of telehealth solutions becoming available. The use of them, especially in Long Term Care or Skilled Nursing Facilities can be transformative. But don't be afraid to demand a solution that will work for the patient in a more holistic way.

If you're investigating telehealth for your facility, download our free guide to hybrid store-and-forward telemedicine:

Photo by Damian Zaleski on Unsplash