Doing a good job of getting patients discharged is key to good patient flow. There are many reasons why patients may not get discharged as soon as they could. Attending physicians at many hospitals don't seem to get around to writing discharge orders until late afternoon or early evening of the day of discharge. Patients sometimes have a hard time getting a ride home. For patients who can't be discharged to home, finding a SNF (skilled nursing facility) or nursing home that can take the patient can delay discharge.

The need to automate discharge workflows is self evident, with vendors and academics focusing on this area. The key is to replace phone tag and a flurry of faxing with an application that spans multiple health care enterprises.

"Before we actually looked at a variety of systems, we were making our referrals to skilled-care facilities and nursing homes by phone," said Dee Mann Aust, director of care coordination for Swedish Medical Center in Seattle, which operates three acute-care hospitals and a free-standing emergency-care facility."It was not efficient," Aust said. "The facility or agency couldn't see a lot clinically about the patient and it was not standard in any way.

We get a lot of patients from Alaska who come here for specialty surgery. They may not have a lot of needs; they just want a local place for their care."

Under the old paper-based system, "Let's say a family picked a geographical area; we'd have to call three nursing homes in the area and give them the (patient) information and see if they could handle the patient," Aust said. "You'd spend five or 10 minutes on the phone for each one. That was just the initial referral."

To address the problem, Aust said Swedish implemented in March 2006 a discharge planning system from ECIN, a developer of a suite of Web-based applications to assist hospitals in discharge planning and care management. Formerly Extended Care Information Network, the company claims installations at more than 300 hospitals and, as subscribers to its Web-based communications service, about 4,200 nursing homes, home health agencies and other long-term-care facilities, according to Charlie Jolie, an ECIN spokesman. In addition, the company maintains an online database of more than 80,000 providers of extended-care services.

The ECIN communication service provides a two-way link between the hospitals and subscribing care facilities. Hospitals typically recruit their local nursing homes to join them on the ECIN network, Jolie said.

The system works well facilitating routine placements and shines when it comes to hard-to-place patients with multiple conditions.

"We know we have some patients who are tough to place, and certainly it's very efficient to create one referral and to send it out to
multiple facilities," Aust said. "We have one patient this week we sent out (referral requests) to 35 nursing homes, and three said they want to look into more information for that patient. So you can do searches within ECIN and their provider database to search if someone has an Alzheimer's unit. That's a big time-saver. You're not depending on what was in last year's entry in a guide. It's more up to date."

In addition to the solution from ECIN, this E-Health Insider story describes what they're doing in the UK. And here's a paper from last year about automating communications between inpatient and outpatient physicians.