Making Meaning out of Avoidable Days

Making Meaning out of Avoidable Days

Avoidable days can impact patient care and social determinants of health (SDoH).

I always love working in the hospital with my fellow case managers, because it reminds me of the relevant issues and topics that colleagues are facing when they show up for work each day.

Today, let’s talk about avoidable days and discharge delays that occur with our patients, and how they can meaningfully impact patient care and social determinants of health (SDoH).

Avoidable days are tracked or logged delays in patients’ progression of care and/or discharge that have led to resource consumption without medical necessity. These days are often categorized by reason and attribution.

For instance, say a patient with a discharge order stayed overnight because they did not have a ride home. The reason is transportation, but the attribution may be nursing, because they did not phone a friend and figure it out. Or consider the patient who waited two days for a consultant to provide services and advise on the care the patient needed. The reason may be cardiology delay, and the attribution is Dr. X of blank cardiology group. Or consider the social admission wherein it is determined that the entire stay should be tracked as “avoidable.”  

Whatever the reason, the goal for tracking these days is not to project them as a meaningless trend line, with a goal to artificially decrease them; this would result in people no longer reporting reasons!

The only reason this information is tracked is so the hospital and/or health system, likely through the case management department, can do something with it and impact change.

If you do not know your hospital’s internal costs, we can estimate, according to Kaiser Family Foundation 2020 national hospital data, that it is about $2,800, per patient day (see reference below). Then you can quantify the numbers to dollars and decide which services should be covered to support the patients’ care delivery and transition of care. 

Going back to my original example, if you have one patient per week who stays overnight because “they didn’t have a ride home,” that is about $145,000 in annual waste, or 3 EVS workers. Turn the information into action by creating a story, as a hospital leader, for example by reaching out to a key foundation, collaborating with your community or post-acute providers, or painting a clear picture for executive leadership and the CFO on what reduction means. I also have justification for why the hospital should just easily cover the ride for the patient home – better yet, with a to-go meal and their prescriptions filled!      

I could ask this question in a lot of ways, but I am going with this: do you know the top avoidable day reason at your hospital or health system?

  • Yes
  • No
  • We do not track avoidable days
  • Does not apply

The responses from Monitor Monday listeners may surprise you; they can be viewed here.

Programming Note: Listen to Tiffany Ferguson’s live reporting on the SDoH every Monday on Monitor Mondays at 10 a.m. EST.

References:

Hospital Adjusted Expenses per Inpatient Day | KFF

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Tiffany Ferguson, LMSW, CMAC, ACM

Tiffany Ferguson is CEO of Phoenix Medical Management, Inc., the care management company. Tiffany serves on the ACPA Observation Subcommittee. Tiffany is a contributor to RACmonitor, Case Management Monthly, and commentator for Finally Friday. After practicing as a hospital social worker, she went on to serve as Director of Case Management and quickly assumed responsibilities in system level leadership roles for Health and Care Management and c-level responsibility for a large employed medical group. Tiffany received her MSW at UCLA. She is a licensed social worker, ACM, and CMAC certified.

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