Welcome to Part 3 of Optimizing Enrollment in Cardiac Rehab, a 3 part series providing methods to optimize enrollment processes for cardiac rehabilitation. In Part 3, we show how inpatient liaisons can bridge the gap to outpatient cardiac rehab. If you haven’t already, check out Part 1, Minimizing Delays, on decreasing the delay between discharge and outpatient enrollment and Part 2, Group Screenings, on the use of group screenings to improve staff efficiency and reduce appointment delays.

With the bundled payment initiative for cardiac care slated to begin January 1st, 2018, affected hospitals are shifting from fee for service to value-based care. The need for effective post-acute readmission prevention strategies are apparent and their components are under close scrutiny.

CMS has outlined cardiac rehabilitation as a key element of a robust post-acute strategy but enrollment rates are low. Enrollment rates of 20% are common and the optimization of contributing processes will be essential to the success of cardiac rehabilitation in a preventionary strategy.

One method to improving enrollment rates is through the use of an inpatient liaison (IL). ILs are staff members dedicated to making contact with patients prior to their discharge. Full or part time, depending on patient volume, the IL provides the patient with basic information regarding the cardiac rehabilitation program and schedules their first visit for phase II CR within 1-4 weeks of discharge, providing a continuity of care that keeps patients engaged and encourages participation.

Inpatient liaisons can have a lot to keep track of and need to be on the move around the hospital. Because of the nature of the position, hospitals should consider equipping ILs with mobile devices. Mobile devices enable on-the-go tracking of patients, can increase communication between staff, and reduce overhead on printed materials.

Below you will find necessary data sources and steps to implementing inpatient liaisons.

Strategy 1: Identify key staff members
As with any effort, the first step is to identify and involve key members of your hospital.
Here are some common titles that should be involved:

• Administration
• Cardiac Rehabilitation Program Director
• Cardiac Rehabilitation Medical Director
• Quality and Process Improvement Department
• Physician Community
• Care Coordinators/Case Managers/Care Navigators

Strategy 2: Determine Physician Engagement

Determine whether physicians are recommending cardiac rehabilitation to patients when meeting in person. If they are not, remind them of the important role they play in influencing patient participation and compliance in cardiac rehabilitation. Make physician engagement a key quality measure. Consider the use of software to enable effective communication between physicians and ILs, ensuring that all qualified candidates to cardiac rehabilitation are visited by the IL.

Strategy 3: Identify necessary data sources
Determine whether your inpatient liaisons will require access to:

• Electronic medical records (EMR).
• Scheduling system database.
• Admission diagnosis CPT codes.

Strategy 4: Identify and integrate technology (for mobile devices)

• Identify software being utilized by staff to schedule and track patients, make sure staff have a shared calendar.
• Consider mobile communication software for ease of communication, helping eliminate work overlap for hospitals with multiple ILs.
• Be mindful of patient privacy when utilizing software and work with IT teams to ensure security and privacy are preserved.

Strategy 5: Establishing order sets

1. Establish order sets for CABG, MI, PCI, CHF, valve repair, and transplants that include automatic orders for outpatient Phase II CR (unless physicians document an appropriate contraindication).
2. Make sure your IL can rapidly respond to order sets and approach patients as early as possible.

Strategy 6: Collect relevant data

1. Create a spreadsheet to track eligible patients who have scheduled their first visit for Phase II CR.
2. Consider using customer relationship management software to make enrollment and visit tracking easy.
3. Calculate percentage of eligible patients that attend.
4. Identify bottlenecks that slow down your recruitment or enrollment based on collected data and devise measures to surmount those barriers. Work with key staff members identified in step 1 to address those barriers.

Though the primary goal of an IL is in the capturing of all qualified candidates to cardiac rehabilitation, they also play an inherently supportive role in the overarching goal of helping patients heal. The IL is in a unique position to engage patients and shift focus from uncertainty to the healing process. They are able to empower the patient through active participation in their recovery and provide comfort by ensuring that the hospital and cardiac rehabilitation program will be there to help. From a hospital perspective, it is the job of the IL to bridge the gap between patient discharge and outpatient enrollment in cardiac rehabilitation, but for the patient, ILs help bridge the gap between uncertainty and recovery.

Some of the strategies above are sourced from AACVPR’s Roadmap to Reform, of which Movn Health is a proud sponsor. This is the final article in the 3 part series Optimizing Enrollment in Cardiac Rehab. Check out Part 1, Minimizing Delays and Part 2, Group Screenings, for additional methods to optimizing cardiac rehab enrollment processes.