The Challenge
Prior to implementing Pings™, Cedar View reviewed hospital discharge summaries upon patient admission and relied on patient or family memory to determine encounter history. External Care Managers would sometimes be able to help piece the history together, but consistently obtaining accurate information proved challenging. Once discharged, Cedar View had virtually no insight into that patient’s movement or other care encounters.
The Solution
Cedar View implemented Pings to obtain real-time insights with respect to patient movement throughout the continuum of care. Team members were trained on the Pings solution’s features and immediately noticed the improved care collaboration outcomes.
The staff commented on the tool’s ease of use and the benefits of having the helpdesk available for assistance on how to utilize a particular feature within the platform.
The team’s favorite Pings feature is the SMS notification option, as it makes the information available right at their fingertips. The team was able to adjust and personalize settings based on their notification preferences.
Workflows
The Cedar View team monitors Pings throughout the day, and especially prior to making a bed offer. If needed, Cedar View reaches out to the appropriate Care Manager to obtain further details on the patient. Upon admission, Cedar View contacts the Community Care Manager and uses Pings to validate the patient’s remaining Medicare days. Pings also allows team members to reach out to prior facilities or home care agencies from which their patients received care.
Currently, the Cedar View team using Pings consists of the facility’s Admissions Coordinator, External Clinical Screener, Facility Care Manager, Social Worker, Administrator and the Director of Nursing. These are the primary team members who receive the Pings and provide timely followup. As soon as a notification is received, the External Clinical Screener and Facility Care Manager are responsible for reviewing and acting on the information.
Patient Success Story
In one instance, an elderly, at-risk patient in the community had a history of frequent hospitalizations and had recently been discharged from Cedar View. Following a hospitalization, the patient denied home care agency entry into her home. Home care reported this incident to Cedar View. Cedar View was then able to monitor that patient in Pings and saw that she presented to the emergency department (ED) following a fall that left her with multiple fractures. Cedar View was able to intervene and welcome that patient back to their facility. Continuity of care provided the patient with a strong discharge plan, which may not have happened had the patient not returned to Cedar View. Pings allowed the Cedar View team to follow her discharge from home care and rehospitalization and allowed for a direct ED transfer, avoiding an unnecessary readmission.
The Impact
Since implementing Pings, Cedar View has seen an overall 3-5 day decrease in length of stay for their Medicare Advantage patients partly due to being able to stay in close contact with the external Care Manager through the contact information provided in Pings. This has allowed Cedar View to reach out right away and ensure that the right providers are involved and engaged with the patients admitted to the facility.
By receiving real-time information via Pings and communicating with external providers, Cedar View has seen an increase in total Medicare days and avoided unnecessary hospitalizations.
In its first year of Pings utilization, Cedar View reported a 6% decrease in readmissions as well as an increase in physician and medical team engagement in Cedar View’s interdisciplinary transition of care programming.
About Cedar View Rehabilitation & Healthcare Center
Cedar View Rehabilitation & Healthcare Center, located in Methuen, Massachusetts, is a skilled nursing facility (SNF) and a proud member of Marquis Health Services®. Cedar View is primarily focused on short term rehabilitation services, with Cardio Pulmonary and Orthopedic specialty programs. The facility has a comprehensive Spanish specialty program focused on meeting the needs of the Hispanic population within the community, as well as a transitional unit to ease patient transitions back into their community or long-term care.
About Bamboo Health
Bamboo Health empowers healthcare organizations to improve behavioral and physical health outcomes through the most powerful care collaboration network with Real-Time Care Intelligence™. By providing real-time insights during pivotal care moments, clients are enabled to perform life-improving actions and deliver seamless, high-quality and cost-effective whole-person healthcare. From coast to coast, Bamboo Health partners with five of the six major pharmacy chains, 52 states and territories, 100% of the top 10 best hospitals and more than half of the country’s largest health plans to improve more than 1 billion patient encounters annually.
