Goldilocks and the “Just Right” Hospital Bed

A Modern Fairytale for the Physician Advisor  

Much like the character from the well-known children’s story of Goldilocks and the three Bears, our  heroine, let’s call her Goldie, was a bit of a perfectionist - always wondering, “could this be better?” No matter the topic, she searched for the ever elusive “just right.” Originally, she focused on simple elements  such as “too hot,” “too cold,” and other simple measures. Over time, other elements were added to the list  of criteria she considered when deciding if something was just right.  

During her earlier years, Goldilocks found herself testing out different pathways through the forest. While the details are not important, these paths led to medical school, military service, and other new experiences.  As a physician, she worked in a dizzying number of locations and clinical settings such as outpatient  clinics, post-acute care settings (e.g. SNF), Long-Term Acute Care Hospitals (LTACH). Some of these facilities are called Critical Access Hospitals (CAH), where Goldie might be the only physician for miles around. Others were large institutions in urban settings, with several hundred hospitals.  

Her itch to make things safer led to innumerable committees, and projects that could be lumped under the general category of process improvement. There were clinics such as anticoagulation, infusion,  cardiac rehab, pre-surgical testing, and too many others to list. Knowing she cannot do this alone, she sought out like-minded individuals whether they belong to (Society of Hospital Medicine, Medicare,  Medicaid, Blue Cross Blue Shield, BOOST, etc.) and formed knowledgeable and experienced care groups  to tackle issues/gaps and heal hospital systems.  

As a Physician Advisor (PA), she followed the principle of “the right place, right time, right patient, right treatment,” when deciding on the Medical Necessity (MN) of a hospitalization. Working as a PA could be frustrating for Goldie. By their very nature, these types of views are never “just right.” Her choices were  actually:  

1. INPATIENT. A patient so sick, that it was clear to everyone that inpatient was appropriate. She wondered why the case would ever be sent to her if it were so obvious. 
2. OBSERVATION. Short-term monitoring and assessment less than 48 hours.
3. I DON’T KNOW. This third group consisted mainly of cases where either the documentation provided inadequate detail to make a determination, or the decision would be based upon the clinical course, and it was too early to tell.  

Rather than feeling discouraged by only 3 options, Goldie wondered “what if we had a way to monitor the system (FHIR® + CART)?” This way we can collect data, make smarter, more informed decisions and build supportive workflows with tools to support continuous process improvement actions. Goldie partnered with SAPHUR.com to create new workflows and tools within her organization. In partnership with Physician Advisors and Hospital leadership, Goldie was able to create solution clarity backed by actionable, supportive data and policies and get things closer to “just right”. 

Learn more about SAPHUR (“Safer”) System Solutions and the CART Transfer Solution today. Sign-up for a free Physician Advisor consultation here.