Improving Financial Performance: Implementation of Levels of Care in An L&D Triage

Rationale: In a licensed 1069-bed tertiary hospital located in the Midwest, our team established an Emergent/Urgent Care Scorecard and Clinic Level Scorecard for use in Labor and Delivery. Scorecards sought to improve documentation and capture costs of nursing time, equipment utilization and supplies associated with patients treated in our triage unit. These pregnant patients present unscheduled to the Labor and Delivery Unit verses going to the Emergency Department seeking care for  non-accidental, non-trauma conditions.  Prior to the implementation of this project, these patients were evaluated in Labor and Delivery, then perhaps sent home. The majority of the costs associated with treating these patients were not captured.

Outcomes: Our multi-disciplinary team was comprised of nurses, physicians, registration, billing compliance, finance, and legal.  The partnerships developed in this team resulted in optimizing health outcomes through the development of criteria, scorecards and policies for nursing, registration and billing.  We improved signage, developed physician orders, flowcharts for decision making, and educational materials for physicians, nurses and professional coders, revised the Labor and Delivery and professional billing forms and developed departmental policy manuals. Timeliness: We began utilizing the scorecard the second quarter of FY06 (October 2005).  Documentation and revenue immediately improved. 

Relevance for women’s health/Implications: The amount generated for this new process since implementation has been over $1.6 million dollars for FY06.