Primary Author:	Maureen Greene, PHD, RN, APNP
Organization	Weaton Franciscan-St. Joseph Campus

Abstract

Purpose

To explore NCM service referral in a pre- and post-decision support EHR application using the EHR nursing admission history of hospitalized medical and surgical patients. Nurse case managers’ priority concerns for referred patients were also examined.

Background

Patients with complex needs should be identified early to mobilize appropriate referral to nurse case management (NCM) services for discharge planning facilitated by the use of electronic health record (EHR) decision-support processes.

Materials & Methods

Retrospective data of hospitalized cardiopulmonary medical and surgical patients was obtained using informatics and manual data collection methods in pre- and post-decision support periods in 2008 from a Midwestern United States city.

Results

There were significantly more NCM service referrals in the post-decision support group suggesting that the addition of auto-referral in the nursing admission history enhanced nurse decision-support. Drug use and use of community equipment and service prior to admission positively predicted nurse-referral for NCM services. Advanced age, overall functional status, drug use and community equipment and service use positively predicted auto-referral to NCM services. Overall cognitive status deficits were a significant predictor for auto-referral to NCM services in the post-decision support group when the variables of overall functional status, prior living arrangement, and age were removed from the logistic regression model. The NCM priority concerns for referred patients included home care agency use, post-discharge placement services, power of attorney document completion, insurance and financial concerns, and oxygen and other home equipment and service needs.

Conclusion

The organized assessments of patients’ needs, using the nursing admission history and a discharge screening tool, could improve NCM referral. Nurse-referral continues to be a valuable nursing critical thinking method to refer patients for NCM services. Auto-referral for NCM services increased when patient factors were used to trigger EHR automatic NCM referral. Further research into the predictive use of functional status, cognitive status deficits, drug use, and community equipment and service factors and age is recommended.

Bibliography

Anderson, J. A., & Willson, P. (2008). Clinical decision support systems in nursing: synthesis of the science for evidence-based practice. Computer Informatic in Nursing, 26(3), 151-158.

Boult, C., Dowd, B., McCaffrey, D., Boult, L., Hernandez, R., & Krulewitch, H. (1993). Screening elders for risk of hospital admission. J American Geriatric Society, 41(8), 811-817.

Bowles, K. H. (2000). Patient problems and nurse interventions during acute care and discharge planning. Journal of Cardiovascular Nursing, 14(3), 29-41.

Bowles, K. H., Foust, J. B., & Naylor, M. D. (2003). Hospital discharge referral decision making: A multidisciplinary perspective. Applied Nursing Research, 16(3), 134-143.

Coleman, E. A., & Berenson, R. A. (2004a). Improving patient care. Lost in transition: Challenges and opportunities for improving the quality of transitional care. Annals of Internal Medicine, 141(7), 533-536.

Coleman, E. A., & Berenson, R. A. (2004b). Lost in transition: challenges and opportunities for improving the quality of transitional care. Annals of Internal Medicine, 141(7), 533-536.

Holland, D. E., & Harris, M. R. (2007). Discharge planning, transitional care, coordination of care, and continuity of care: clarifying concepts and terms from the hospital perspective. Home Health Care Service Quality, 26(4), 3-19.

Holland, D. E., Harris, M. R., Leibson, C. L., Pankratz, V. S., & Krichbaum, K. E. (2006). Development and validation of a screen for specialized discharge planning services. Nursing Research, 55(1), 62-71.

Naylor, M. D. (2002). Transitional care of older adults. Annual Review of Nursing Research, 20, 127-147.
© Improvement Science Research Network, 2012

The ISRN published this as received and with permission from the author(s).