SHM Converge Scientific Abstract ePoster Gallery-Accelerating Patient Acquisition in a Hospital-at-Home Model

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UNC Health’s Advanced Care at Home (ACH) program is a hospital-at-home model launched in 2021 that has served 2,000 patients. Because CMS waiver rules require patients to originate from the emergency department or a hospital bed, acquiring appropriate patients is complex and labor-intensive.  <br /><br />Previously, ACH relied on shared responsibilities among providers, a nurse admissions officer, and the clinical manager. Eligible patients were placed on triage lists based on payer and zip code, but their status was documented in a free-text box with labels such as “Early Emergency,” “Evaluation,” “Contact,” or “Accepted.” This created problems: no clear task ownership, duplicated reviews, and poor follow-up for patients who were initially too sick or on observation status.  <br /><br />To improve the process, ACH leadership worked with an EHR analyst to redesign the workflow. The triage lists stayed the same, but the free-text system was replaced with a structured flowsheet containing three stages: Initial Triage, Needs Clinical Review, and Needs Social Stability Review. A “Review Needed By” date was also added to ensure continued follow-up of patients who were not yet ready for admission.  <br /><br />This change improved visibility into workflow, clarified who was responsible for each step, and helped track the number of screening touches needed. Since implementing the new process in July 2024, ACH has seen consecutive months of census growth, with average daily census increasing from 11.2 in January–June 2024 to 15.11 in July and August.  <br /><br />Overall, the standardized workflow improved patient acquisition and supported the financial sustainability of the hospital-at-home program.

Asset Subtitle

Patrick M. O'Shea

Meta Tag

Author List Bailey Beauclair, Ila Mapp, Lenora Britton, Michael Craig, Michael Piscitello, Patrick M. O'Shea, Simone Autry, Teresa Thacker

Category Innovations

Concept Home-Based Acute Care

Concept Patient Acquisition

Concept Task Ownership

Concept Workflow Standardization

Concept Average Daily Census

Distinguished Non-Finalist

Presenter Organization University of North Carolina School of Medicine

Presenting Author Patrick M. O'Shea

Track Other

Keywords

UNC Health

Advanced Care at Home

hospital-at-home

patient acquisition

EHR workflow

triage lists

structured flowsheet

CMS waiver

census growth

clinical review

Home-Based Acute Care

Patient Acquisition

Task Ownership

Workflow Standardization

Average Daily Census