Optimizing Coordination Among Mid-Revenue Cycle Stakeholders

By: Tim Brundage, MD, CCDS
Medical Director & Chief Executive Officer, Brundage Group 

Across many hospital systems, the demand for patient beds outweighs the supply. This can lead to a plethora of problems, including surgery cancellations, declining patient and staff satisfaction, and increased length of stay for patients in every setting, e.g., inpatient, emergency department, etc. Further, when capacity is a problem, hospital leadership spends unnecessary time addressing capacity management issues—valuable time that cannot be regained. 

Hospital leadership would agree there is a need to develop a strategic process to manage bed capacity. Ideally, a plan would be developed through collaboration of hospital leadership and hospital-wide staff, with solutions that focus on maintaining or improving quality and outcomes.
From a staffing perspective, when staff efficiency increases, employees are less burdened with managing capacity issues and more focused on patient care. For patients, having a bed available in the right setting makes them feel valued and cared for, resulting in a positive effect on patient satisfaction and outcomes. 

Emergency Department (ED) crowding is not a problem that exclusively impacts the ED, but rather one that impacts all patient care areas and requires hospital-wide solutions. Long wait times can lead to potential safety events and dissatisfaction with overall care. Addressing ED crowding should be at the forefront of organizational improvement efforts, as it is costly and compromises care quality and public perception and trust. 

The Pilot
Brundage Group embarked on an ambitious pilot project to solve patient throughput issues by targeting patients with hospitalization orders who remained in the ED awaiting bed assignment. Integral to the project was a dedicated physician advisor in the ED to help optimize workflows, admission, and discharge processes. The goals of the pilot were to confirm accurate level of care orders at the time of admission; reduce avoidable admissions; and improve communication between the ED physician, admitting hospitalist, and ED case manager. 

The ED project was a collaboration between Brundage Group and a Level 1 Trauma Center that is one of the largest hospitals in Florida. A hospital representative will co-present the session, Optimizing Coordination Among Mid-Revenue Cycle Stakeholders, along with physician advisor, Dr. Timothy Brundage, during ABQAURP’s Annual Health Care Quality & Patient Safety Conference. 

The Team
The project team included a physician advisor as the dedicated resource for the pilot; a utilization management nurse to create a UM presence that did not previously exist in the process; an ED care coordinator/case manager (CM), who refocused efforts to prioritize ED discharge planning; and an ED social worker (SW), who remained focused on serving ED patients. 

New Concepts 
The team developed a process to target "boarder" patients - a patient who requires care beyond ED services but remains in the ED because there is no hospital bed available. As part of the pilot, the project team would meet in the ED at multiple standing times throughout the day to review all boarder patients. 

To help encourage efficient patient throughput, the team leveraged case management services. While CM is required for inpatient, the team realized the CM role could also be applied in the ED to help support the patient discharge process as appropriate while enabling the ED to treat a greater capacity of patients. During the frequent meetups, the team leveraged these dedicated ED CM/SW teams to identify patients for whom referrals could be obtained for additional services allowing discharge directly from the ED. 

Level of care determinations had a two-prong approach. Led by the physician advisor, the boarder round team helped to ensure appropriate level of care status and would contact the attending physician if a status order needed correction. Additionally, UM nurses were tasked with reviewing ED cases outside of boarder rounds, referring identified cases directly to the dedicated ED physician advisor. A key element was the physical placement of the UM nurse within the ED to directly communicate with ED physicians as quickly as possible to support accurate status determination and maximize real-time communication. 

Outcomes
The results of the pilot program showed significant reduction in avoidable admissions, validated patient status determinations, and a change in the ED physician culture, becoming more confident that discharge planning could be safe and efficient with appropriate support from the CM/SW role. 

The outcomes underscored the need for a dedicated ED physician advisor to add credibility to the project and to optimize the discharge process. Further, reviewing a case for appropriate level of care early in the ED stay improved the accuracy of level of care determinations and ultimately improved hospital capacity management. The pilot project also spurred a change in ED physician culture that extended to the general medical staff through education and physician advisor engagement. 

Learn about the specific outcomes of the emergency department pilot program during Dr. Timothy Brundage’s session at the ABQAURP Annual HCQ&PS Conference, “Optimizing Coordination Among Mid-Revenue Cycle Stakeholders,” on Friday, October 7, 2022, at 4:30 p.m. For more information and to register, visit: www.abqaurp.org/AnnualConference.

Transformational Leaders: Redesigning Population Health Through Technology, AI, and Resilience

October 6-7, 2022 - Sheraton Sand Key Resort - Clearwater Beach, FL
Early Registration - Save $50 by May 31st!

While COVID caused much loss and despair, exposing the many gaps in pandemic readiness, infrastructure needs, education, and communication strategies; it also provided a perspective on what could be accomplished when we collaborate, innovate, and stand tall with resilience! Although we are by no means through to the other side, lessons learned from this experience will be the basis for transformational leaders to redesign the landscape for ongoing population health improvements. 

Join other transformational leaders at ABQAURP's Annual Health Care Quality & Patient Safety Conference in Clearwater Beach, FL; come together to discover the innovations and approaches that have evolved from the swift changes made throughout health care. Together, we can move forward with a health care system that is more resilient and stronger than ever before.

We invite you to join your colleagues in Clearwater Beach! Register for the Conference Now! 

Don't Forget Your Room Reservations!

Our discounted room rate of $179 is first come, first served. Don't miss this opportunity to stay at the conference location at this great rate! To read about St. Petersburg-Clearwater's Visiting Responsibly tips, CLICK HERE.

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Join ABQAURP in Celebrating Nurses Month!

"As a nurse, we have the opportunity to heal the heart, mind, soul and body of our patients, their families and ourselves. They may not remember your name but they will never forget the way you made them feel."
- Maya Angelou

The impact of nurses on health care is unparalleled directly affecting the health and well-being of our society. Nurses are everywhere we live, work, play, learn, and worship, and in every health care setting providing care to millions of people. 

ANA selected the evergreen theme, Nurses Make a Difference, to honor the varying roles of nurses and their positive impact on our lives. Nurses make a difference as trusted advocates who ensure individuals, families, and populations receive quality patient care and services. Nurses make a difference by influencing and shaping health policy decisions that ensure all Americans have access to high-quality, affordable health care coverage. 

A month-long celebration of the nursing profession allows for greater opportunities to promote understanding and appreciation of the invaluable contributions of nurses. The month will be divided into four weekly focus areas — Self-Care, Recognition, Professional Development, and Community Engagement.

ABQAURP would like to thank all Nurses for the caring work they do each and every day. Thank you for your hard work and dedication to quality health care and patient safety!!

Historically, National Nurses Week takes place each year from May 6 through May 12, Florence Nightingale's birthday. These permanent dates enhance planning and position National Nurses Week as an established recognition event. In 2020-2021, in celebration of The Year of the Nurse, Nurses Week was expanded through the month of May. For more information, visit: https://nursesmonth.org/about-nurses-month/.

A Message from our Corporate Member

For those considering a future as a physician executive, stepping into the role of a Medical Director of Advisory Services with Sound Physicians is an excellent professional development opportunity. In this role, you will work elbow-to-elbow with physicians, staff, hospital leadership, and utilization management personnel in a non-clinical capacity to provide direct education and support in critical areas, including patient status, clinical documentation, compliance, and utilization management. While some of our advisors come to us with experience in an advisor role, we take pride in helping physicians through a career transition to an advisor. Join our team and lead the transformation of the acute episode of care. 

Click Here to Learn More   

Transitions of Care News

NTOCC recently announced the new release of the 2022 Care Transitions Bundle Seven Essential Intervention Categories. Since its first development and release in 2011, the Care Transition Bundle has been used to help develop transition and care coordination programs throughout the health care industry. 

The NTOCC Care Transitions Bundle is not a specific transition or care model but rather a listing of seven key interventions that health care professionals can consider in developing or enhancing transition and care coordination services. The Care Transition Bundle lists seven intervention categories, provides simple descriptions for each intervention, then expands each description with examples for considerations by providers. NTOCC has now added an optional appendix for health care professionals to download, which includes terms and explanations that may not have been in use as widely when the original document was created, along with a new graphic to use as a guide. The 2022 Care Transition Bundle now has a sleek look and has been designed to be more user friendly when developing and implementing your transitions of care program and process so that you can tailor it to your specific healthcare setting. 

The webinar NTOCC hosted describing the updated Bundle is available on-demand as a complimentary online CE course through ABQAURP’s Center for Continuing Education. You can register here: https://education.abqaurp.org/topclass/topclass.do?expand-OfferingDetails-Offeringid=1082930. 

AHRQ’s Patient-Centered Outcomes Research Strategic Framework: Request for Public Comment

AHRQ is seeking public comment on the proposed strategic framework for the Agency’s Patient-Centered Outcomes Research (PCOR) Trust Fund investments through fiscal year 2029. The framework was developed in response to the reauthorization of the PCORTF and will guide future planning and evaluation of AHRQ’s PCORTF investments. The strategic framework aligns with AHRQ’s mission and broader goals of improving the quality, safety, equity, and value of healthcare delivery. 

The draft framework currently identifies five priorities for advancing healthcare delivery and improving patient outcomes. These interrelated priorities are intended to achieve the proposed framework’s overall vision of delivering equitable whole-person care across patients’ lifespans. 






AHRQ hopes to receive feedback from patients, healthcare professionals, community groups, employers, health services researchers, dissemination and implementation scientists, communications experts, representatives from health systems, public and private payers, and other stakeholders. The input received from this public comment period will be used in refining and finalizing the strategic framework. 

Comments must be submitted no later than May 24, 2022. For more information, including a link to submit your comments, CLICK HERE. 

For more information on the framework, read AHRQ Views: Blog posts from AHRQ leaders.

You can also find details in the April 15th Federal Register. 

2022 HCQM Certification Exam - Save $50 by May 16th

Certification in Health Care Quality and Management (HCQM) is for physicians, nurses, and other health care professionals who are committed to Health Care Quality and Patient Safety. Validate your expertise by earning the Certified in Health Care Quality and Management (CHCQM) credential! 

The 2022 HCQM Exam window will be open from June 1 through September 30, 2022. Apply early for your choice of date, time, and location. Remote testing is available through ProProctor™ - a remote testing platform that allows candidates to test anywhere, at any time. 


Additional Sub-Specialties are available: 

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Is Your Continuing Medical Education Accredited?

ABQAURP welcomes applications for joint providership of educational activities for continuing medical education credit. ABQAURP accredits a variety of activities including live activities, enduring materials, and more.

As an accredited provider, ABQAURP works with each joint provider organization to ensure the accreditation process runs as smoothly as possible. 

For more information, please contact the Education Department at (800) 998-6030 or education@abqaurp.org. 

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