7:15am – 8:00am
Conference Registration & Networking Breakfast 

8:10am – 8:50am
How to Improve Outcomes, Decrease Readmissions, Increase Bed Capacity, Increase Efficiency, Improve Throughput and Ensure Financial Viability
The factors, both internal and external, that affect the healthcare system and the trends impacting individuals and organizations will be enumerated. The impact of the emergency department as the driver of the system will be discussed. What are the problems confronting health care and how can we effectively address them to have a positive impact on those in healthcare, hospital systems, and more importantly, our patients and their families. What are cost-effective, simple, easy to implement, proven effective approaches to dealing with the healthcare crisis that can instituted by any healthcare system? A blueprint for addressing these issues will be outlined. Practical examples of how to deal with these difficulties will be discussed. Successful methods for dealing with the patient without definitive criteria for admission, the elderly, the psychiatric patient, the complex patient with multiple comorbidities, the patient with social issues, and others will be reviewed. Practical examples including individual care plans, multidisciplinary teams, specialized care clinics, geriatric nurse clinicians, observation medicine, ensuring follow-up and outpatient services, delivering medical care in the home, and the use of technology will be discussed.  A pragmatic approach with realistic, achievable methods or tools for addressing the many issues affecting healthcare will allow us to successfully meet the challenges and create an optimistic future.

Sharon E. Mace, MD, FACEP, FAAP
Professor of Medicine
Cleveland Clinic Lerner College of Medicine of Case Western Reserve University
Director, Research, Emergency Services Institute (ESI)
Former, Director, Observation Unit, ESI
Cleveland Clinic

8:50am – 9:30am
Admissions Begins with Discharge: The Sooner, the Better
One of the most important duties healthcare professionals have is to “ready” patients for discharge. Educating patients about their medical conditions, medications, self-care strategies and the importance of follow-up care can help patients maintain an optimum level of health and reduce their chances of readmission to the hospital. The goal of discharge planning is to provide a safe discharge plan that is enough to ensure that readmission isn’t likely. Early, transparent communication between patients, their caregivers, the care team, and discharge planners is essential to that process. Topics to be discussed will include:

• Begin planning for transition from the acute setting before the patient arrives
• Integrating discharge planning into care management programs
• Actively engaging family or other caregivers in early in the process
• Leverage technology to identify at risk patients and communicate across the continuum.
• Addressing nonmedical needs such as transportation to the doctor’s office or a pharmacy
• Building teamwork between acute and post-acute care settings Process

Carissa J. Tyo, MD, FACEP
Medical Director, Clinical Decision Unit
Medical Director, Care Management and Physician Advisors
University of Illinois Hospital & Health Sciences System 

9:30am – 10:00am
Networking & Refreshments Break 

10:00am – 10:40am
Implementation of a Discharge Readiness Playbook while Leveraging Technology
Bottlenecks and patient flow are a challenge each organization faces with increasing ED and Ancillary Boarders along with a lack of coordination between departments for awareness of patients discharging. By creating a standardized process for preparedness of discharge through flowsheets, checklists, compliance with EDD, discharge monitor provided an increasing percentage of discharges by noon and 2pm. Creation of an evidence-based playbook outlining 8 "Must Haves" for the sites to implement outlining roles and responsibilities for each discipline. Each “must have” utilized a supporting metric for continuous process improvement. This presentation will review the implementation of the discharge readiness playbook, piloting outcomes with a statistical analysis, strategies for large healthcare systems for further implementation reviewing lessons learned, barriers, opportunities for improvement, success and EPIC supporting tools for discharge readiness.

Cori Garner, MHA, BSN, RNC-OB, NE-BC
Director, Patient Command Center
Advocate Health 

10:40am – 11:20am
Enhancing the Patient Discharge Process
Discharge planning is essential to ensure both the patient’s needs for continuing care are addressed and compliance with applicable regulations are met.  A team-based approach and shared decision-making model are essential components for a safe and effective discharge plan, but care teams often work off their own agenda resulting in silos. If individual team members are working towards their individual goals, the discharge process will become a competition of metrics rather than a betterment of transition.  Communication is key to enhancing the patient discharge process.  Delivery of discharge instructions is often rushed and disorganized, leaving the patients and families with poor comprehension and a subpar patient experience.  Implementation of key multidisciplinary communication strategies will not only improve discharge metrics but also improve quality metrics and coveted patient satisfaction scores. Such strategies demonstrate that an institution has superior communication skills that result in effective exchange of information with patients, families,  and other health care professionals.

Lisa Giocondi, M.B.A., RN, FACHE
Operations Manager | Department of Critical Care | Department of Emergency Medicine & Observation Medicine | Mayo Clinic Arizona 

11:20am – 12:00pm
Using Quality Improvement Tools to Optimize Hospital Efficiency and Reduce Length of Stay
Delays in the discharging process can affect hospital efficiency. Improving patient flow in hospitals is an essential issue that hospital management aim to achieve. Hospital length of stay (LOS) is a quality metric health systems use as a proxy of efficient hospital management. Reduction in LOS improves bed turnover, allowing hospitals to match demand with capacity for elective and emergent admissions, intensive care unit (ICU) care, and interhospital transfers. When demand exceeds capacity, emergency department crowding, ICU strain, and ward strain occur, all of which are associated with worse outcomes. This session will explore interventions to reduce hospital length of stay to optimize hospital efficiency.

Judy Ducsik
Executive Director
Providence 

12:00pm – 1:00pm
Luncheon 

1:00pm – 1:45pm
RN Discharge Planners of The Future: Developing an RN Residency Program for new Case Managers
Hiring and onboarding nurses into Case Management, specifically discharge planning, can be challenging for organizations. The hiring and onboarding process for new case managers can be complicated and overwhelming. Discharge planning is so dynamic and stepping into the role of a case manager can be challenging to navigate. Finding the right fit for a Discharge Planning role is so essential to the overall success of the department and the organization. This session will contain an overview of the development, implementation, and sustainment of an RN Case Manager Residency program, sharing successes and lessons learned over the years.

Barbara Farrell, MBA, BSN, RN, CCM
Director, Integrated Case Management
Sarasota Memorial Healthcare System

1:45pm – 2:45pm
Panel: Reducing the Length of Stay by Enhancing the Patient Discharge Process
Delays in the discharging process can affect hospital efficiency. Improving patient flow in acute care hospitals is an essential issue that hospital management and research aim to achieve. For years, hospitals have responded to inefficiencies by adding more resources, whereas research suggests that it is a flow problem. This session will explore how to enhance patient flow through improving patient discharge and reducing length of stay. Interventions will be discussed, including dedicating slots in diagnostic services for discharges, improving communication, eliminating pending exams, identifying discharges the day before, prioritizing laboratory tests, coordinating discharge medication processing and utilizing case management.

Panelists:

Victoria V. Dune-Chari, FACHE
AVP – Operations & Transformational Excellence
Wellstar Health System 

Barbara Farrell, MBA, BSN, RN, CCM
Director, Integrated Case Management
Sarasota Memorial Healthcare System 

Lisa Giocondi, M.B.A., RN, FACHE
Operations Manager | Department of Critical Care | Department of Emergency Medicine & Observation Medicine | Mayo Clinic Arizona

2:45pm – 3:30pm
Improving Early Discharges with an Electronic Health Record Discharge Optimization Tool
Delays in hospital discharge can negatively impact patient care, bed availability, and patient satisfaction. Obtaining accurate clinical information about recent acute care visits is extremely important for outpatient providers. However, documents used to communicate this information are often difficult to use. This puts patients at risk of adverse events. Elderly patients who are seen by more providers and have more care transitions are especially vulnerable. Hospitals have increasingly focused on optimizing patient flow to improve care and reduce potential harm. Discharge delays prevent newly admitted patients from being placed in the right bed at the right time, often leading to emergency department overcrowding, patient dissatisfaction, and adverse events. During high-census periods, the lack of available inpatient beds can lead to the diversion of critically ill patients, canceled surgical procedures, or postponement of scheduled admissions. This session will explore how could be created in the EHR to assist medical care teams with improving DBN percentage on busy, academic teaching services.

Benjamin S. Dangerfield, DO
Medical Director, Arizona Operations Command Center
Mayo Clinic 

3:30pm – 4:00pm
Networking & Refreshments Break 

4:00pm – 4:45pm
Enhancing Patient Flow Efficiency: Leveraging Data and Stakeholder Collaboration within a Throughput Governance Council
A focused approach to optimizing patient flow within hospitals by harnessing the collective expertise of a Throughput Governance Council comprised of essential stakeholders. Through the application of process improvement strategies and data-driven insights, this approach aims to streamline patient movement, reduce wait times, and enhance resource allocation. By fostering collaboration among key stakeholders and leveraging data analytics, this methodology ensures that process enhancements align with strategic objectives and result in tangible improvements in patient flow, ultimately leading to more efficient and effective healthcare delivery.

Leah Davenport
Throughput Manager
Ascension Saint Thomas Rutherford

4:45-5:30pm
Leveraging Hospital Command Center to Increase Tertiary/Quaternary Transfer Volume
A Command Center plays a crucial role in increasing tertiary quaternary (TQ) hospital to hospital transfers by streamlining the process and enhancing communication among healthcare providers. The Command Center serves as a central hub that monitors bed capacity, track patient flow, and coordinate the transfer of patients between hospitals. By leveraging technology and data analytics, the Command Center identifies available beds and transfer opportunities in real-time, enabling healthcare providers to make informed decisions quickly. Additionally, the Command Center facilitates communication between referring and accepting hospitals, ensuring that patients receive the appropriate level of care and reducing the risk of delays or complications. By utilizing the Command Center to optimize hospital-to-hospital transfers, healthcare organizations can improve patient outcomes and enhance their reputation as a provider of high-quality care. Moreover, such transfers can contribute to the financial success of the hospital by attracting more Tertiary Quaternary patients, increasing case volumes, and generating additional revenue, ultimately fulfilling the hospital's mission of providing specialized care while achieving financial success.

Scott Jahnke, MBA
Patient Flow Command Center Director
UCLA Health

5:30pm
End of Day One

7:15am – 8:00am
Networking Breakfast 

8:00am – 8:10am
Chairperson’s Recap 

8:10am – 8:50am
Discharge Process and Check List: Tales from the Trenches
Discharge planning is complex but can be made easier if it starts early and it is a multidisciplinary action.

This presentation will highlight all the basic and necessary steps to complete a safe and timely discharge

• Determine what post discharge care patient needs, including services and equipment.
• Making sure that all stake holders are involved early in the discharge plan.
• Patient and family, care givers, need to be active participants.
• Identification of barriers to timely discharge.

Tibian Abramovitz, MD
Medical Director for Utilization Management
Maimonides Midwood Community Hospital 

8:50am – 9:30am
Overcoming Reimbursement Challenges
Hospitals do not receive reimbursement for the costs associated with caring for patients for the additional days they are in the hospital while they wait to be discharged. These additional costs further strain hospitals across the country that are dealing with a range of financial pressures from historic levels of inflation to skyrocketing costs, as well as their own workforce challenges. Hospitals’ expenses are projected to increase by $135 billion. This session will explore strategies to help mitigate the costs of caring for patients for these excess days in the hospital, and how to ensure that patients are getting the most appropriate care possible.

Matthew Ducsik, MPH
Associate Vice President, Providence Clinical Institutes
Providence Clinical Network

9:30am – 10:00am
Networking & Refreshments Break 

10:00am – 10:40am
Improving the Emergency Department Discharge Process
Millions of patients visit hospital emergency departments each year for a variety of injuries and ailments. It is crucial for these patients to receive appropriate preparation for their return home so that they can properly manage their recovery. Emergency department (ED) discharge failure, such as ED return within 72 hours or more, poor compliance, or lack of comprehension, carries significant clinical implications for patients, including unfinished treatments and progression of illness. This session will explore strategies to improve the ED discharge process.

Anthony J. Guarracino, DO, MHS, FACEP, FACOEP
Chair, Emergency Medicine
UPMC Pinnacle 

10:40am – 11:20am
Capacity Management in a Post Pandemic Era
Form many health systems, continuously experiencing surge capacity conditions requires 24/7 engagement of all leaders from the Executive team to front line managers to facilitate patient throughput. Engaging cross-functional teams in visualizing end-to-end patient flow operations through a value stream enables the team to identify waste and bottlenecks within their processes, develop an aligned ideal state vision, and deliver a robust improvement plan to drive breakthrough results. This session will expose leaders to throughput value stream management system and the most impactful improvements that can be replicated in many organizations to improve patient flow.

Victoria V. Dune-Chari, FACHE
AVP – Operations & Transformational Excellence
Wellstar Health System

11:20am – 12:00pm
Improving Patient Flow—In and Out of Hospitals and Beyond
Smoothing the flow of patients in and out of hospitals and other healthcare settings can help to reduce overcrowding, prevent poor handoffs, and avoid delays, all of which may worsen as more people gain access to insurance coverage and care. Many hospitals and health systems are pursuing strategies to improve patient flow such as orchestrating the arrival and discharge of patients undergoing elective procedures and transferring the oversight of patients waiting to be admitted from emergency departments to other hospital units. Topics to be discussed will include:

• Putting an end to long stays in the ED
• Timely discharge
• Smoothing patient flow in operating suites
• Improving admissions
• Improving continuity in primary care

Keith Grams, MD, FACEP
System Chair, Emergency Medicine
Rochester Regional Health

12:00pm – 12:40pm
Creating Capacity for the High Acuity Patient:  The Impact of Community Hospital Utilization
Assuring adequate capacity of the tertiary/quaternary facilities within a health system is a complex and multidimensional challenge.  Maintaining availability of high acuity beds, while managing system resources to mitigate capacity imbalances is crucial in ensuring the quality and safety of patient care. The overcrowding of emergency departments, scarcity of specialized services in the community, and delays in discharges and transfers negatively impact the efficient utilization of resources for high-acuity patients requiring prompt attention. This session will explore the potential barriers to capacity creation and further identify potential solutions through utilizing the high-leverage change concept of shaping or reducing demand, as articulated by IHI’s white paper “Achieving Hospital-Wide Patient Flow”.  This session will also explore lessons learned from implementing pathways that improve community hospital bed utilization to increase the capacity of high-acuity hospital beds.

Heather Brooks
Director of Patient Logistics and the Hospital Transfer Center
Penn State Milton S. Hershey Medical Center

12:30pm
Conference Concludes

12:45pm – 2:45pm
Utilizing Technology to Enhance Discharge Planning and Patient Engagement
Pressure on hospitals to reduce unplanned rehospitalizations, improve patient engagement, and optimally utilize scarce resources continues to increase. Research shows that approximately 15%^[1],[2] of patients with social determinants of health and multiple comorbidities are rehospitalized within 30 days of discharge. By holistically addressing these challenges, hospitals can improve care coordination, reduce manual and redundant discharge planning processes, and ensure patients have a successful after-discharge experience. This session will explore how best to enhance your existing EHR and integrate the latest cutting-edge technologies, including virtual care, artificial intelligence or machine learning, and mobile enablement—functionalities that, when combined, can be powerful tools to improve patients’ after-discharge engagement, reduce unplanned, all-cause 30‑day rehospitalizations, and decrease the discharge planning burden on inpatient case managers.

Sandra Myerson, RN
Principal
ECG Management Consultants 

Kathryn Lavoie
Senior Consultant
ECG Management Consultants

[1]             Average hospital readmission rate by state, Definitive Healthcare, www.definitivehc.com.

[2]             The HCUP Nationwide Readmissions Database (NRD), 2020, www.ahrq.gov.