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Laurie Gautney, R.N., M.S.N. at Brookwood, works with the ECIN system.

Several local hospitals now use digital networks to streamline the discharge placement process. This summer, Baptist Montclair and Princeton hospitals installed a Web-based program from Patient Placement Systems (PPS) of Alpharetta, Georgia.

"PPS has been quite a time saver," says Toni Uffinger, Princeton Social Work Coordinator. "Under our old system, when a patient needed to be discharged to a nursing facility, for instance, we might call four or five acceptable facilities and, of course, we'd often end up playing phone tag. Once we reached the admissions coordinator and found bed space, we'd usually need to follow up with more information either by phone or fax. Then we'd wait to hear back from them."

"Now, I can run down the list of facilities on my computer, check the ones acceptable to the patient, and then I fax the documents one time to PPS, where it goes into their server. The server sends the information to selected facilities and within minutes, we can have a response. We might get replies from several facilities that say they have bed space and believe they can meet the patient's needs. They might ask us to call to discuss further."

"Under our old procedure, the process took, at a minimum, two to three days. If the patient was denied on the third day, I had to start all over. Now I make most placements in a single day."

Placement time has likewise improved at Brookwood Medical Center, where case managers are part of the Extended Care Information Network (ECIN). ECIN is like a web browser," says Laurie Gautney, R.N., M.S.N, Clinical Excellence Manager. "It interfaces with our Admission Discharge Transfer (ADT) system. We can create an information packet on a patient where we include their lab work, medications, and other pertinent information. With one keystroke, we can then send out an inquiry to a broad list, for instance all the nursing facilities in a particular part of town, or we can do an advanced search of facilities, based on specific parameters. For example, if a patient needs dialysis, we can search for facilities near dialysis centers."

The PPS and ECIN systems both safeguard patient privacy. The initial inquiries are sent as blind packets, with anonymous patients, and contain minimal information. "We send out just enough to get a bite," Gautney says.

Follow-up from the initial inquiries is expedited with wireless communications. Nursing facilities and other providers can respond by sending text messages to case managers' pagers or cell phones. Case managers, roaming the hospital, are able to keep up with discharge arrangements on the go. "It's freed us up a little," Gautney says. "And not just on the receiving end. We can work on our information profile right there in the patient's room, typing data into our laptop while talking with them. At the same time, I can print up a packet for the family, along with a map to the various nursing facilities."

Toni Uffinger has also found the digital system to be helpful when she is on-call on weekends. If questions arise about a patient who has been discharged by another social worker, Uffinger can log into the system with her user ID and password and access all the relevant information, allowing her to answer questions by phone, rather than driving in to the hospital for a non-emergency.

For the most part, providers are adapting well to the new process. Although Sherrie Young, Admissions Coordinator with Trussville Healthcare, misses the personal relationship with case managers engendered by phone interaction, she has found the systems to be a big help with record keeping. "We maintain these records on the computer," Young says. "That helps a lot because the paper charts are being picked up and put back so many times during the day, that when you need a chart, someone else might have it. And with all the handling, there's a chance that some information might come off the chart. With this system, it doesn't matter if it was a year ago or ten years ago, you have all the information from the original chart on the computer."

Both Laurie Gautney and Toni Uffinger are happy with the new systems. "There's a huge void between paper and computer charting," Gautney says. "We're all trying to head towards fully computerized records. No one is really there yet. We've all got a long way to go. But this is a good step that allows us to keep moving in that direction."

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