Coordinating Care From Hospital to Home

Planning For a Catastrophic Case Discharge

The following case study illustrates the complexities of hospital discharge planning and the potential for readmission in catastrophic cases. This case describes the process of injured employee care and problem resolution as approached by the case manager and the Apricus care coordinator.

The Problem

A 29-year-old male employee was injured on the job in a motor vehicle pinning accident. The injured employee suffered a catastrophic injury and was diagnosed with the following:

• Crushed pelvis
• Crush injury/fractures to lumbar/sacral spine
• Massive internal trauma and vascular dissection

The injured employee remained hospitalized for four and a half months due to the extreme injuries sustained and a major complication associated with a non-healing open wound that further delayed his final discharge.

Case Background

In preparing for the injured employee’s initial discharge from the hospital, the case manager maintained frequent contact with the injured employee, his wife, hospital personnel and treatment team. The case manager anticipated the injured employee would have numerous discharge needs, including various durable medical equipment (DME) products, home modification, and home health services and began working with the hospital treatment team to secure orders ahead of the injured employee’s expected discharge date.

After securing the initial orders, the case manager contacted Apricus with the referrals and orders. Upon confirmation of receipt, an Apricus care coordinator began communicating with the case manager on the injured employee’s discharge orders. Working as a team, the case manager and Apricus care coordinator reviewed pertinent information on the injured employee’s requirements, updates on his condition, coordinated healthcare needs and discussed his anticipated hospital discharge date.

The injured employee’s hospital discharge needs included:

• Bariatric customized wheelchair
• Building a wheelchair ramp
• Bariatric walker
• Bariatric tub bench
• Home health
• Home physical therapy/occupational therapy
• Wound care services
• IV fusion services

The care coordinator went to work securing the needed products and services. While orders came in piece by piece leading up to the injured employee’s discharge date, even last-minute orders were successfully fulfilled by the care coordinator before the injured employee returned home. After a nearly four-and-a-half-month hospitalization, the injured employee was able to safely discharge home with his needed supplies and resources in place to begin his next phase of recovery.

The Results

Unfortunately, after just two weeks of being discharged from the hospital a specialized wound care RN noticed abnormal wound drainage and swelling on the injured employee. The findings were communicated to the internal medicine/trauma team and case manager. The employee was immediately sent to the emergency room for a thorough medical diagnostic examination and was admitted for an additional week’s stay in the hospital due to early-stage sepsis, a potentially life-threatening condition.

This triggered a second hospital discharge order including:

• Pick line supplies and specialty antibiotics
• Continued home health
• Continued home physical therapy and occupational therapy (expected another month)
• Wound vac (expected another month)
• Wheelchair, walker and bed (expected for another three months)

By maintaining close contact with the injured employee and Apricus team of providers, further debridement, additional hospitalizations, and a potential intensive care unit (ICU) stay, were all prevented due to the quick action of the nurse and teams involved.

The Apricus Advantage

As can be seen from this case, case managers working with care coordinators for specialty services can make a significant difference in an injured employee’s long-term health. With input from all parties involved in hospital discharge planning, the case manager ensured the injured employee received the most appropriate treatment for optimal recovery. The case manager worked with Apricus, the specialty solutions provider, to deliver quality equipment and services to meet all service dates and needs and made sure the injured employee and his wife felt their needs were being addressed and coordinated in a timely manner throughout the process.

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