IU Health Ball Memorial's treatment guidelines are both diagnosis-based and procedure-based, and the organization now has more than 200 guidelines in place, each created by an interdisciplinary team with a physician champion.
The team created these order sets for the hospital's own skilled nursing facility and then tailored the guidelines so that they can be followed at any SNF, regardless of size or resources.
"At first, we created standardized order sets for our own skilled beds, and worked internally to streamline that whole process and make sure that the essential orders were there," says Pat Gorman, RN, IU Health Ball Memorial's director of case management. "We took it a step further when we worked on heart failure. We created a heart failure skilled care order set and met with the administrator and director of nursing to make sure what we were putting on the order set could be used anywhere."
Caregivers also meet monthly with local SNFs to discuss patients' conditions and ensure they are providing the best continuum of care.
At the 525-licensed-bed Lancaster General Hospital, treatment guidelines for its heart failure outpatients began to form about 13 years ago when the leader of its chronic HF program, Roy Small, MD, decided to put all HF patients on one floor. That program was physician-directed and nurse-practitioner–implemented. Small then developed an inpatient HF clinic staffed by nurse practitioners. Small is also president of the Heart Group, whose parent company is Lancaster General Health.
"The NPs get to know the patients very well, so by managing both inside and outside the hospital with that model really helped start us down this road of keeping these complicated patients out of the hospital," says Paul Casale, MD, Lancaster's medical director of quality and head of cardiology.
Lancaster also developed a large Transition of Care Committee that links the specialists in the hospital to patients' primary care physicians and SNFs.
"We have a large family practice physician base because Lancaster has a nationally well-known family practice residency program, and a lot of residents stay in the area, which is important so the patients have the primary care link," Casale says.