While these questions are the basics for preparing for a long stay or outlier case review, they are the questions that should happen in every hospital's planning rounds. The environment of all patient planning forums must become one of low defensiveness and low tolerance for status quo, with high creativity and near boundless exploration of alternatives in a team setting. The work demands skillful conversation. It makes leaders out of each and every participant in the care transition planning process. An end product of this process is a greater understanding of the reasons why the case became an outlier.
Patterns become evident.
These patients typically experience over 7 procedures per stay, are cared for by an average of 4 physicians, have an average 11 non-physician referrals by case management to expedite care, and average 69 years of age. Armed with some degree of predictive indicators of the long stay case, we can then make recommendations for system changes. Any case over 10 days could become their domain. The barriers are not merely in planning discharge arrangements. They are in lack of clinical progression due to a host of reasons.