Rhode Island: A Look at How a Neonatal Intensive Care Unit Team is Using ADT
Larry T. Jessup, MHA, Kristina Celentano and Joyce Coutu | November 3, 2014
Health care organizations using clinical alerting in Rhode Island are seeing improved outcomes and measureable reductions in 30-day hospital readmissions, duplicate testing, and fewer emergency department visits that result in a patient being admitted to the hospital.
An “ADT alert” is a real-time clinical alert of an admission, discharge, or transfer (ADT) encounter sent to a care coordinator or primary care physician to notify them about a patient’s status in a hospital or emergency department (ED). Once alerted to a patient’s status, care providers can take action to improve care coordination, including but not limited to scheduling follow-ups, ensuring the patient understands discharge instructions, or calling the emergency department to recommend a patient to another care delivery setting such as a skilled nursing facility.
Reduced Readmissions, Better care, and Cost Savings in Rhode Island
In an effort to improve care coordination, the Rhode Island Quality Institute (RIQI) , which serves as both the state’s regional extension center (REC) and health information exchange (HIE), successfully ties all of Rhode Island’s commercial hospitals to the state HIE, known as CurrentCare . This enables Rhode Island providers who receive hospital alerts from the RIQI to get a complete picture of where their patients are being admitted, discharged or transferred.
RIQI conducted an analysis of the readmission rates for patients enrolled in CurrentCare and found that over a 30-day period, all cause hospital readmission rates were approximately 18 percent lower for patients whose primary care providers use hospital alerts than for other CurrentCare patients whose primary care provider does not use alerts. This difference, as illustrated in the table below, reflects a potential cost savings of approximately $1.4M.
Clinical Alerting and Consumer Engagement in Rhode Island
Hospital alerts are used across the entire spectrum of health care settings, including those who care for the youngest, most fragile infants. In October 2012, the Rhode Island regional extension center assisted state’s Women & Infants Hospital program, Partnering with Parents , to provide transitional support services to infants and families during their stay in the Neonatal Intensive Care Unit (NICU) and post-discharge. As part of the program, parents or guardians are offered the option to enroll their infants in CurrentCare before discharge; the Partnering with Parents team then follows the infant for three months. Data from the program show that 63 percent of the parents and guardians of these premature infants agree to enroll their newborns in CurrentCare.
The Partnering with Parents supervisor recently testified before the Rhode Island Senate Health and Human Services Committee on the success of the program. Program team members have grown to depend on the Current Care Alerts to give them prompt notification of when one of their enrolled infants has an ED visit or a hospital admission. Once they receive the alert one of their team members immediately contacts the family to determine if they are receiving adequate support, and to ask if they can intervene to prevent further complications. In a recent case one of their infants was brought to the ED by her mother due to concern the infant might be wheezing. The ED did not find any respiratory issues of concern and the infant was discharged home. In response to this event the team brought the infant into their Neonatal Follow-up Clinic the following day for further evaluation and was able to determine the infant was experiencing reflux, causing the infant to cough and appear to have labored breathing. They initiated treatment and the infant has done well at home since. Being able to respond to these events in such a timely manner has undoubtedly allowed the Partnering with Parents Program to prevent additional ED visits and allow them to maximize the support families receive when transitioning their fragile infants home.
These families get peace of mind knowing the care team will be notified if they need to go back to the hospital for any reason. The team also uses CurrentCare Viewer to access demographic information and other clinically relevant information such as medications and imaging results. As of January 2014, the Partnering with Parents Transitions Home Project has enrolled 542 infants (and their families) in the program and of those, 312 infants are enrolled in CurrentCare.
Clinical Alerting shows positive results for patients and providers
Getting the right information to the right people at the right time for effective intervention and management is key to improving health and health care as well as lowering costs. As an emerging standard of care in Rhode Island, over 174 practices have implemented alerts and as of September 2014, over 61,502 alert messages were sent since the service launched.
The results of the 2014 Annual Rhode Island Provider Survey illustrate that more than half of the respondents are using hospital alerts and nearly all of them have found it to be a helpful service in providing quality care to their patients.
Dr. Martin Kerzer, a family physician at Associates in Primary Care Medicine in RI, noted that “hospital alerts have facilitated continuity of care for our patients. Our goal has been to contact all of our patients who have been in the hospital or the ER within 24 hours. With hospital alerts we are approaching that goal. One of my complex patients was discharged from the hospital and since alerts are received in real time, my nurse care manager was able to contact the patient immediately after discharge, as well as speak to the patient’s visiting nurse and arrange for her follow up care.”
CurrentCare hospital alerts provide real-time information in a way that is easily actionable and closes gaps in transitional care communication. As millions of patients are discharged or transitioned to other care settings every year, this automated communication tool is crucial to ensure that transitions of care are coordinated in a way that does not disrupt continuity of care. ADT alerting is one method that is proving to be effective in Rhode Island to break down communication barriers, support reductions in 30 day-hospital readmissions, and improve health outcomes.