Coordinating efforts in the electronic medical record (EMR) and across disciplines are keys to tackling the social determinants of health (SDoH) – and specifically, transportation.
Discharge delays related to transportation, whether avoidable or not, are a common occurrence for hospitalized patients. Some patients may have been transported great distances to a regional hospital, and now they need to return home, or they are being discharged to an alternative location and need transportation support to get to a post-acute location. Sometimes it is simply a delay because they do not have anyone to pick them up from the hospital, or they do not have a car that happens to be in the parking lot to drive themselves home after an emergency-room visit, procedure, or hospitalization. When appropriate, conversations with the patient and/or representative about potential discharge transportation needs should occur early in the hospitalization. In fact, a proactive approach would be to incorporate this as protocol.
As we approach the social drivers of health requirements, hospital personnel are required to ask questions regarding transportation insecurity. Although I am not thrilled with the Health-Related Social Needs (HRSN) wording of questions related to transportation (as I think they are a bit cumbersome, and do not fit into natural conversation), one can easily still assess for patients’ potential transportation needs. Things I would want to know are if my patient is:
- Able to drive independently;
- Unable to drive or does not have access to transportation;
- Uses an insurance transportation benefit;
- Uses family or others for rides;
- Primarily uses public transportation; or
- Has no transportation resources.
Pending a response, one would want to provide necessary resources to the patient, as well as comments to the care team regarding what’s needed for the patient upon discharge to ensure that they are able to head home or to the post-acute facility timely and safely, without avoidable delays related to transportation insecurity. This may be an opportunity to develop outreach and provide resources to patients regarding community support services that allow them to be more successful in obtaining services related to their healthcare. At this time, consults for the post-acute resource center (PARC) could occur to ensure that the patient has a bus pass – or, one might give the transportation coordinator a heads-up that this patient will require a ride at discharge.
From a coding perspective, the conditions impacting the patient’s hospitalization could be assessed if Z59.82, transportation insecurity, applies.
If this information was at the patient level in the medical record, the entire inpatient and outpatient care team could be aware of the transportation modality and provider the patient uses, with access to phone numbers should issues arise.
From a data perspective, this information, listed in discrete fields, would allow the healthcare organization to assess how often patients are presenting with transportation needs and/or potential insecurity. Once quantified, there may be an opportunity for the hospital to partner with an outside vendor for transportation, or to purchase a shuttle to take patients home.
Does your hospital or healthcare organization struggle with patient transportation issues?
Programming note: Listen to Tiffany Ferguson’s live reporting on the social determinants of health (SDoH) Tuesdays on Talk Ten Tuesdays with Chuck Buck and Dr. Erica Remer.
