PeraHealth Insights

3 Ways Predictive Analytics is Improving Transitions of Care



What comes to mind when transitional care is mentioned and what does it really mean? Transitional care is meant for continuity of care in the healthcare industry ensuring that patient transfers and handoffs are executed efficiently and effectively as the patient moves from one care setting to another. Transfers among units and across facilities involve a significant amount of information balancing. The systematic approach of transferring and accepting patients is routine for most hospitals and clinicians, yet even with the assistance of predictive analytics, protocols, and workflow management, transitional care still has opportunities for improvement.

Let’s dive into three specific ways that healthcare facilities can improve workflow and equip clinicians with advanced tools to impact care administration.

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Improving communication between Care Providers: For most hospitals, communication amongst clinicians can be chaotic, misinterpreted, and overwhelming at times. In a CRICO strategies study, communication failures were linked to “1,744 patient deaths in five years and $1.7 billion in malpractice costs”. A significant part of the communication gap can be attributed to a lack of resources and insight to understand which patients are at risk for clinical deterioration, let alone mortality.

Implementing an effective clinical solution which allows clinicians to visualize and communicate present and past patient acuity across encounters supports both cross-facility and regional transitions of care.

Rapid Response Protocols: Rapid response teams (RRTs) identify deteriorating patients to prevent ICU transfers and reduce preventable deaths. Monitoring and identifying at-risk patients is often done reactively, however earlier intervention can be accomplished by purposefully moving away from a reactive approach, and employing a proactive response approach. Unfortunately, identifying patients proactively is a difficult task unless clinicians are able to visualize a patient’s clinical trend, thus identifying deteriorating at its earliest point. When clinicians can holistically view clinical acuity, proactive rounding ensues allowing RRTs the opportunity to assess the most pressing patients first, thereby preempting further deterioration.

Mitigating Emergency Department Crowding by Improving Patient Flow: Emergency Department (ED) crowding contributes to long wait times, a potential for compromised care, and affects community perception and trust, among other impacts. Improving patient flow through the hospital is one way to alleviate ED overcrowding. The Institute for Healthcare Improvement, the Joint Commission, and the Institute of Medicine, along with other organizations, encourage hospital leaders to implement patient flow improvements acknowledging this is a key ingredient to resolving ED overcrowding.

Through the utilization of a communication tool that allows clinicians to visually understand patient acuity trends in real-time, clinicians are able to:

  • Identify at-risk patients and move them to a higher level of care. This scenario may occur within the four walls of an organization, or in a community-based hospital with the clinician determining the patient may require additional resources based on the patient’s current clinical status

  • Identify patients that may currently be in an ICU that could be more appropriately cared for in a stepdown or medical/surgical unit in order to open a bed for a patient who may be higher risk.

Utilizing predictive technology during transitional care improves communication between care providers, assists RRTs in identifying at risk patients to intervene proactively, and facilitates the decision-making process for patient ­flow. The Rothman Index (RI) supports intrafacility, interfacility including regional transitions of care. By taking advantage of this clinical surveillance solution, healthcare systems, such as Mission Health, have been able to visualize a patient’s clinical condition an­d subsequently develop or adjust plans of care as needed to prevent adverse patient outcomes. On July 20th, two nursing experts from Mission Health will be discussing how they have been able to support transitions of care with the use of the RI.