Caring for the Survivors of Critical Illness:

Posted by liamjonh225 on October 24th, 2022

It was clear to us and to the hospital’s leadership that improving care and out- comes for this population was a priority. Additionally, key stakeholders of Eskenazi noted trends within the larger healthcare environment highlighting the need for im- proved care of these patients. Specifically, it was becoming more common for hospitals to care for critically ill patients, as opposed to those with lesser condi- tions or simply chronic diseases like hypertension or diabetes.MedsDental is a renowned Dental Billing Company in the united states, equipped of  the revenue cycle experts who are highly proficient in delivering fast and the error-free billing services to the dental practices by using the cutting edge technology.   

Several adminis- trators took notice of this trend and saw high-quality post-ICU care as a marketable attribute of the facility. This was also a time when federal reimbursement systems (Medicare and Medicaid) began to hold hospitals accountable for the care of pa- tients for a period of time after their initial hospital discharge. In the years to come, multiple federal quality reporting programs would begin to measure the rates of 

hospital readmission within 30 days. Those hospitals that fared worse relative to their peers would face potential financial penalties in the form of lower reim- bursement. So, in addition to improving care for patients surviving the ICU, there was a significant business case to be made that confirmed demand within the insti- tution for a solution to the issue of designing care for the ICU survivors. To address this need, we created the Critical Care Recovery Center (CCRC) with a goal of providing collaborative care to ICU survivors.¹³ The first step in the CCR- C’s creation was to gather an interdisciplinary team from the critical care and geri- atrics divisions at the Indiana University School of Medicine who had used collab- orative care models for patients with dementia, depression, and other geriatric syn- dromes. Many on this team had previously developed research protocols and re- search tools to meet the complex recovery needs of ICU survivors and found them- selves tasked with how to transfer their research discoveries into a clinical delivery process within the CCRC. Initially, we used the HABC as a model for the CCRC. The HABC had demon- strated a positive impact on the care of patients and unpaid caregivers living with Alzheimer’s disease within its first years of existence, and we felt it provided an effi- cient model for how to structure the CCRC. Brainstorming sessions and deliber- ations regarding the CCRC’s structure and functioning started well in advance of its opening. We held quarterly meetings in 2010 and 2011 to discuss strategy, using the same Agile Implementation process.Managing the billing process accurately is not easy as providers might face hurdles in revenue cycle management. Moreover, Net Collection Rate below 95% shows that your practice is facing troubles in the billing process. To eliminate all these hurdles and maintain your NCR up to 96%, MedsIT Nexus Medical  Coding  Services are around the corner for you so that your practice does not have to face a loss.The meetings involved all stakeholders:leadership from Indiana University School of Medicine’s critical care and geriatrics divisions; the Indiana University Center for Aging Research; and critical care nurs- ing, physical rehabilitation, and neuropsychology departments. Through these meetings the stakeholders recognized and codified the vision for improving the cognitive, physical, and psychological outcomes of ICU survivors. The meetings also provided the time and space for the stakeholders to develop relationships, re- flect on the challenges, and identify the minimum specifications for the CCRC. Potential members were identified for the smaller operational teams that would meet weekly to solve problems, monitor progress, and—once the program launched in July 2011—make timely modifications based on incoming data. The delivery team identified four minimum specifications for the CCRC regard- ing patient care:  1.Maximize full cognitive, physical, and psychological recovery following hospitalization for a critical illness 2.Enhance patient and family caregiver satisfaction 3.Improve the quality of transitional and rehabilitation care 4.Reduce unnecessary hospitalizations and ED visits  To identify the minimum specifications for the CCRC, we leveraged guidelines and evidence-based protocols already in existence to identify crucial aspects such as: performing an early assessment of functionality, providing patient and unpaid 

caregiver education and coaching, and monitoring health outcomes longitudinally. However, we had to adapt these concepts to the local environment to be used by the CCRC. To translate components of the evidence-based protocol locally and to meet the cognitive, functional, and psychological needs of ICU survivors and their family caregivers, we employed multiple “sprints.” Sprints are short, intense cycles of implementation where components are put into practice to see how they perform and function at the local level. After a sprint, staff provide feedback regarding their experience and discuss potential adjustments they feel would make the process more effective and sustainable. Appropriate modifications are made before the next sprint, and this iterative process continues until all are satisfied that the compo- nent is at its most effective for the local environment and intended use. As an example, during one of the first sprints we observed high rates of no-shows to the first CCRC visit. This reflected the lack of an adequate link between ICU discharge and subsequent care through the CCRC. To address this, we added a direct referral from the ICU for 90 days after discharge and set up a pre-clinic phone call with pa- tients and their unpaid caregivers. The purpose was to make sure they understood the benefits the CCRC could provide them. We immediately saw a drop in the rate of no-shows.