SHM Converge Scientific Abstract ePoster Gallery-Improving Patient Care Through Inter-Service Collaboration

Pdf Summary

This pilot program addressed rising admission denials, financial pressure, and patient concerns about unnecessary hospital stays and costs. The goal was to improve patient care and hospital efficiency by ensuring patients were admitted at the right level of care, avoiding inappropriate admissions, reducing rework from incorrect status placement, and educating Emergency Department (ED) providers on better admission practices and outpatient alternatives.<br /><br />The hospital used InterQual, a standard medical necessity screening tool, with key stakeholders including emergency medicine providers, admitting physicians, physician advisors, and utilization review nurses. Admission requests were tracked by provider and measured against inpatient, observation, or no-level-of-care criteria. Providers with unusual admission patterns were identified for feedback.<br /><br />Implementation included training ED and admitting staff on medical necessity and proper admission status assignment. Utilization review nurses performed real-time preadmission reviews using InterQual, with communication handled through Epic Secure Chat. After six weeks, results were shared with ED leadership, and providers with higher-than-expected admission rates received one-on-one education. The team also reviewed trends related to shift changes, throughput delays, and discharge opportunities.<br /><br />The intervention improved discharge processes, documentation quality, timeliness of care, and overall throughput while reducing denials. It led to a 16% increase in patients meeting inpatient level-of-care criteria after targeted education. Of patients identified as meeting inpatient criteria during initial review, 88% were ultimately discharged as inpatients without authorization denials. Total daily admissions decreased by 3–4 patients compared with historical averages. The authors estimate this could save the hospital $3–4 million annually by avoiding unnecessary patient days.

Asset Subtitle

Peter Emerson

Meta Tag

Author List Abhi Jawanda, Bhavesh Patel, Melissa Buchner-Mehling, Peter Emerson

Category Innovations

Concept Admission Accuracy

Concept InterQual

Concept Medical Necessity Criteria

Concept Inappropriate Admission

Concept Upfront Status Accuracy

Distinguished Non-Finalist

Presenter Organization Sound Physicians

Presenting Author Peter Emerson

Track Quality Improvement

Keywords

admission denials

medical necessity

InterQual

level of care

utilization review

emergency department

inpatient admissions

observation status

hospital throughput

patient education

Admission Accuracy

InterQual

Medical Necessity Criteria

Inappropriate Admission

Upfront Status Accuracy