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Addressing Discharge Barriers at UMass Memorial

Kevin Reynolds
Kevin Reynolds, RT 

A multi-department project to reduce radiology discharge barriers and improve communications has had significant impact on patient care. The secure chat process between the clinical services and radiology to facilitate timely discharges that radiology staff helped build and implement was featured in a white paper by Catalysis.  Kevin Reynolds was part of a promotional podcast for the project as well.

Excerpt from Catalysis White Paper

Radiology services understood the challenges faced by clinical teams. “[This project] comes from, in a way, a request from our providers, but also from Radiology, to really enhance communication on a variety of fronts,” says Dr. Steven Baccei, Radiologist, Vice Chair for Quality, Safety, and Process Improvement, and also the Associate Chief Medical Officer for UMMMC. “We have phone numbers for our reading rooms and our procedural areas. We have pagers for radiologists, but it’s not the same radiologist necessarily working every day. It’s difficult at times for teams requesting procedures and imaging that may require contrast or other preparation. They found at times that it’s difficult for them to get through to us and to have those communications be in a timely manner. It’s really timely communication they eventually get through to us, but they really want timely communication.”

Steven Baccei, Professor Radiology UMass Chan Medical School
Steven Baccei, MD

Radiologists similarly had difficulties reaching clinical teams when they have questions about prep or procedures that have been done prior to the patient arriving at Radiology. They, too, were leaving voicemails, messages, and emails; simple questions could take hours for an answer, if one came at all. “The hospitalists change over every eight hours or every 12 hours,” adds Dr. Baccei. “Residents are constantly rotating in and out. Nurses do eight-hour shifts. Patients are moved from floor to floor. And so we really needed to find a way to streamline to directional communication related to Radiology procedures and Diagnostic Imaging.”

Kevin Reynolds, Radiology Technologist and Senior Clinical Quality Manager notes that prior to the project Radiology services did not have routine access to the Avoidable Bed Day Report, and so staff were not fully aware of the extent of the problem. They would receive information at the end of the month when excessive discharge delays were reported and attributed to Radiology. He and Dr. Baccei began to examine the data on avoidable bed days to ascertain the true causes; sometimes it was related to Radiology, but other times there were clinical issues that contributed to the delay. They realized that better and more timely communication from both ends clinical teams and Radiology could prevent many delays long before discharge was to take place.

The improvement project team found that radiologists and technologists did not have easy access to two critical pieces of information:

  • Estimated discharge date for the patient, which could help them to prioritize orders to those closest to a discharge time, thus reducing the need for clinical teams to request urgent service turnarounds.
  • Members of a patient’s treatment team and their contact information, to which they could more accurately reach out with questions and help them deliver more timely service.

Epic's Secure Chat Utilized

Once the IS analysts established the Secure Chat functionality in Epic, which appears at the top of the Epic main screen, they added the chat groups for the various Radiology divisions computed tomography (CT) scan, ultrasound (US) radiology, and interventional radiology (IR) imaging and clinical teams. With the technical structure in place, the improvement team established a plan, a standardized process, and rules for how all parties would interact within Secure Chat to communicate delays in care or send questions to and from Radiology divisions.

Availability for Secure Chat was set from Monday through Friday from 8:00 am to 4:00 pm (extended hours are possible if availability is indicated by a division). Clinical teams providers, nursing, case management generate a message by clicking on a “Groups” tab and entering a group name. During multi-disciplinary rounds (MDR), if a patient is identified as “pending discharge” and needs CT/US/IR imaging, a Secure Chat message is sent to the appropriate Radiology division. Secure Chat also could be used if a delay has been identified (from a prior shift or day of service) or if a patient is identified later in a day as a potential discharge.

Efficient Communications

The more efficient communications format has replaced frustration among staff with improved accountability and cooperation. “It gives the people doing the work tremendous pride in their accomplishment and in their solution,” says Elizabeth Trumble, MBA, CITC Lean Six Sigma Black Belt. “They solved it. They bought into it. They helped design it. They helped refine it, and they own it.”

Read the entire White Paper about the project:
Podcast with Kevin Reynolds and Elizabeth Trumble: