Beyond the Scope of Work

The primary function of Third Eye Health serves to bring access to our board-certified physicians on nights, weekends, and holidays when attending physicians are on call and unable to lay eyes on patients.  Using our secure telehealth technology via an iPad, nurses connect with Third Eye Health physicians in less than two minutes who, on most occasions, treat patients in place without a transfer to the ED and the added risk of an unnecessary readmission.  While treating in place is the core objective when becoming a Third Eye Health facility, there are several additional benefits to appreciate.

Transfer Preparation

While Third Eye Health physicians do have a 90% treat in place record, there are times when our doctors will recommend an acute care transfer due to the circumstances of the consultation.  On such occasions, our physicians may stay online with the nurse through the iPad, assisting in the preparation of the transfer.  If necessary, our physicians can assist the staff nurse with additional orders that could include oxygen, nitro to mentions a few common orders.  Our physicians also can communicate directly with the paramedics when they arrive, relaying pertinent details if needed.

Risk Mitigation

Following each Third Eye Health coverage period, each facility receives a summary of every encounter, alerting the Director of Nursing and the attending physician of any activity that occurred with each patient.  Beyond a simple summary, our Care Coordination Managers, who are all nurses by trade, apply a high level of scrutiny while reviewing each case.  They take the time to look at patient medical history, especially in cases that raise flags of concern.  This is an invaluable service. Our Care Coordination Managers serve as an extra line of defense, providing a second set of eyes for DONs and nurse leaders to review patient encounters and find areas for improvement, for the center, and for the Third Eye Health physicians who are consulting patients.

Case Study: Initiating Plans of Correction

Extension of the Clinical Team

Each Care Coordination Manager works closely with their centers.  Following every Third Eye Health physician encounter, the Care Coordination Manager reviews the progress notes and orders conducting quality analysis checks, ensuring all orders are signed and notes are complete.  Center Directors of Nursing and attending physicians rely heavily on the daily care summaries provided by their Care Coordination Manager to understand the care their patients received while on our watch.  In addition to care summaries, the Care Coordination Manager also establishes a regular metric review, bringing together the center’s clinical leadership time to collaborate on improving care based on the metrics presented.  In some instances, they may review a particular case, or in others the Care Coordination Manager may find reoccurring issues in her metrics that may need to be addressed and work together to establish new protocols that would better serve the patient population.

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A Third Eye Health Care Coordination Manager, conducting the daily report, came across an encounter for a change in condition noting skin discoloration, signaling an end of life.  Eventually, the patient did pass away.  Upon further review, looking at past medical records for the patient, the Care Coordination Manager uncovered several concerns involving this case that, if reviewed by the Department of Health, could be seen as a deficient practice by the center.

Challenge:

Looking back at the deceased patient’s medical records, the Care Coordination Manager noticed that the patient had a central line.  Further analysis revealed that there were no orders for the care, treatment, or flushing of the central line, though.  Additionally, a redness, possibly indicating an early-stage infective process, had been noted but with no mention of a doctor being notified. Whether protocols were not in place or not being followed for patients with a central line, this is an issue that would raise red flags should the Department of Health review this particular case.

Solution:

The Third Eye Health Care Coordination Manager presented the facts of the case to the center’s Director of Nursing and Regional Medical Director during a routine metric review.  Noting that it had the potential to be flagged by the Department of Health for several issues, this became a teaching moment for the center.  By catching the issues ahead of any audits from the state, they were able create and execute a plan of correction around central line protocols and several other issues identified by the Care Coordination Manager.

Benefit:

Taking the time to review a patient’s complete medical history, while ideal, is a rarity for a Director of Nursing with no shortage of tasks on their plate. Unfortunately, under most circumstances, it is the state that ends up finding these errors in care. By meticulously reviewing this patient’s record, the Third Eye Health Care Coordination Manager was able to bring forward several issues to the center’s clinical leadership, pinpointing areas that would cause alarm for any audits the state might conduct.  While the patient’s death itself was not unusual, by looking back through the complete medical record, areas where protocols were not in place or applied were now identified.  With this information, the center proactively expedited a plan of correction, training its nurses and setting processes in place to prevent future reoccurrences.  This will be especially beneficial should the Department of Health review this case, they will see that the building took the initiative to improve the quality of care they are providing.

Result:

By immediately creating this correction plan, showing that they have educated the nurses, and that the changes have been put to action ensuring such an event will never occur again, the center is now prepared when the Department of Health arrives.  Upon investigation of the deaths, the Director of Nursing will be fully equipped with a well-documented plan of correction, showing what measures have already been put in place to ensure quality improvements and prevention of reoccurrence. By showing diligence in recognizing the issue and already initiating a plan of correction and future prevention, the center may receive a tag for this case, but will be able to prevent an even more severe punishment such as being put in jeopardy by pausing new admissions, inflicting punitive financial damages, and declining CMS star ratings and reimbursements.

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