Leading through the pandemic; changing thoughts and perceptions one patient at a time. Health systems are traditionally comprised of people, institutions and resources that deliver health care to a targeted population or region. Small hospitals often agree to partnerships or takeovers by larger systems because of their struggles to manage decreasing insurance reimbursement rates or their desire to invest in costly new technology, such as EHR systems. In most cases, the hospital continues to function as a separate entity with governance from a corporate structure. While the system provides guidance, supply chain resources, clinical expertise, and financial support one function remains entity driven: hospital capacity. As the Covid-19 pandemic infiltrated health care, it became patently obvious that while supply chain products were a logistic nightmare, so was patient logistic management. Small hospitals are like a gift box; they can only hold so many patients. Along with that space constraint also comes the human capital factor. While boarding patients is commonplace in some regions; additional staff is needed to care for these patients. So how does a small community hospital exponentially grow over night? The answer is simple; think of all beds in the healthcare system as one hospital. MedStar Health is the largest healthcare provider and a comprehensive system across Maryland and the Washington, D.C. region with including more than 300 care locations, 9 acute care hospitals, 1 nationally renowned rehabilitation hospital, 33 urgent care clinics, ambulatory care centers, and primary and specialty care providers. There are also many telehealth options for urgent (eVisit) and non-urgent (Video Visit) care solutions, and with world renowned experts in infectious disease and infection prevention. The acute care hospital capacity is approximately 2700 beds. The combination of beds and clinical expertise equates to One MedStar. Accomplishing the One MedStar philosophy was not easy. The region, and country, was in the throws of the worst pandemic in a hundred years. The infrastructure of a central command center did not exist. There was an infancy of clinical care transformation and a mindset of individual hospital ego. To combat the urgent need for care coordination the MedStar Triage Office (MTO) was conceived to facilitate capacity management. The initial team was led by a critical care physician and the medical director of the MedStar Transfer Center. To support this team each hospital inaugurated a physician and nurse lead to participate in the triage process. The Hospital Triage Officers (HTO)were tasked with monitoring patient acuity, available capacity, repatriation, and care coordination. As the HTO’s matured the teams grew to include many interdisciplinary members. Because of the COVID visitor restrictions and the complexity of the patients care coordination from the onset was imperative. While many insurance companies, Medicare/Medicaid and jurisdictions relaxed requirements; there was still the element of patients and families needing assistance and guidance. The process of repatriating or returning to original hospital, required care coordination by physicians, nurses and social workers. Repatriation was a life saver, literally. This function allowed for real-time system capacity management and beds to be readily available at the large tertiary hospitals for the critically ill patients at the small community hospitals. In the period from April 2020 to June 2021 the MTO coordinated 2391 requests for capacity management transfers. This is an average of 3.3 transfer per day. These were in addition to the specialty care needs from around the region. During the pandemic waves, it was recognized that this capacity management coordination was pivotal to creating capacity availability as the system returned to normal operations. With surgeries returning to normal, emergency departments back to pre-COVID levels and the new comradery between hospitals this is the optimal time to provided system resources for this venture.

OBJECTIVES:

• Discuss health care trends and strategies that improve patient outcomes across the life span while meeting the needs of multiple populations.
• Compare the impact of health care trends on the practice of case management, and the role of the case manager.
• Identify resources that influence the advancement of case management and the body of knowledge.

PRESENTER:
Lorelei Stellwag, DNP, MSN, RN, NE-BC