Direct Admit System for Hospitals (Dash): Improving the Direct Admission Process Using Technology

Background:

Many outpatient clinicians find obtaining a direct admission for the stable ill patient into the hospital difficult and time consuming; they instead send the patient to the ED, where critical time is lost and health care dollars are wasted. Hospital direct admissions account for 47% (16 million) of total annual hospital admissions in the United States. Unfortunately, the current direct admission process is mired in inefficient communication, poor care coordination, and delay in obtaining a bed. To improve this process, we have developed and implemented software to streamline the coordination of the direct admission process.

Purpose:

To address the current inefficiencies in the direct hospital admission process by implementing DASH (Direct Admit System for Hospitals), software that enhances the coordination of each step to efficiently and safely secure a bed for an ill patient, obtaining timely inpatient care.

Description:

As primary care physicians and then as hospitalists, we had encountered many of the obstacles posed in obtaining a direct admission for our patients. We identified each hurdle that referring clinicians faced in securing a direct admission and designed a system that is easy to use, ensures continuity of care, and seamlessly coordinates admission into the hospital. We developed a Web‐based Direct Admit Form that can be accessed by the staff at the referring medical facility (for example, clinics, urgent care centers, extended‐care facilities) or via a smartphone app. For ease of access, we distributed to these facilities a “Direct ADMIT” button connected via USB to their computers. On clicking, the Direct Admit Form is displayed on their screen. The HIPAA‐compliant and secure form allows for entry of patient information, uploading of medical records, and input of preliminary orders. On submission of this form, an SMS text alert is sent to the hospital admitting physician (AP) and hospital bed coordinator (HBC) on their smartphones, where they can then access the admission via the DASH App. The AP reviews the information on the admission “DASH Board” and can then click on the “DOC‐to‐DOC” to discuss the case with the referring clinician further. Once the AP clicks “accept admission” and the HBC assigns a bed in the system, a “Hospital Boarding Pass” is generated. This boarding pass provides all pertinent information for the patient to be taken directly to their hospital bed on arrival.

Conclusions:

DASH has been implemented in 3 large regional hospitals, accounting for well over 800 admissions. The time from bed request to patient arrival has been slashed in half to less than 3 hours, directly expediting improved health care delivery. The ALOS was cut by 0.5 days, saving the hospital on average $1042/admission by reducing medical utilization, eliminating ER wait, avoiding redundant testing, and improving hospital throughput.

DASH Direct Admit System for Hospitals process flow overview.

Clear Lake Regional Medical Center August–December 2012 form submission to patient arrival time.