Admission, discharge, Transfer (ADT) Transition of care process Workflows

Workflow for Inpatient Alert

CM Workflow for Discharge Alert

CM Workflow for ED Alert

continued on next page

ADT Alerts Best Practice Process The following steps are completed by the CM 24-48 hrs. after alert notice. Acknowledge receipt of admission, discharge or ER alert from CCM. Investigate patient change in status and determine care management intervention. Document receipt of alert, intervention(review of EMR and follow up with facility contact, patient and physician) and planned follow up with patient in EMR.

Transitions of Care Integrated Workflow (displays inpatient, discharge and ED flows in one screen)

ADT/CTC Summary of Key Points Alerts need to be acknowledged on a timely basis throughout the day to minimize multiple alerts on the same patient. (i.e. admission alert that is not acknowledged by the time of discharge will generate another alert -> discharge alert) When acknowledging an alert by email, click on “view care plan” button once logged in CTC. Clicking “close” will remove alert from your home page and require you to look up patient by name. ( Patient hospitalization report is being developed via CTC website to see patient TOC activity.) It is recommended that review of the discharge disposition code be incorporated into your process.