Initiative makes it easier for YNHHS to help patients who can't speak for themselves

What happens when a patient becomes too ill make medical decisions for him- or herself?

If the patient previously completed advance directives forms and named a healthcare representative to make those decisions, hospital staff work with the representative to provide the kind of care the patient desires. (Learn more about advance directives and download forms at ynhhs.org).

But a number of patients don’t have advance directives. In those situations, the family and/or hospital may have to ask the probate court to appoint a conservator to make decisions on the patient’s behalf about medical care and the resources needed to support the discharge plan.

“In some cases, post-acute care organizations such as skilled nursing facilities will not accept patients until a conservator is appointed to handle financial matters related to the patient’s medical care,” said Kasia Bogusiewicz, LCSW, Yale New Haven Hospital Social Work manager. “That makes it difficult for us to plan for the patient’s future care.”

The process of obtaining a conservator takes time, and can result in longer hospital stays.

“Within Yale New Haven Health System, at any given point, an estimated 30 patients were in hospital beds who didn’t need to be there because they were waiting for a conservator to be appointed,” said Katie Arcangelo, RN, a consultant with YNHHS’ Office of Strategy Management (OSM).

In March, the OSM began working with physicians and representatives from Social Work, Care Coordination, Legal, Behavioral Health and other departments on a clinical redesign initiative to develop a more consistent and efficient conservatorship process. It’s the first project involving Social Work systemwide.

Previously, each delivery network had its own guidelines for identifying the need for a conservator and steps for obtaining conservatorship for patients.

The new YNHHS conservatorship process, which launched Aug. 1, combines elements from each delivery network with best practices from other healthcare organizations. Key components include a checklist that helps clinicians and other healthcare professionals determine whether a conservator is needed; one lead person – usually a social worker or care coordinator – who oversees the conservatorship process from beginning to end; communication with and education for family members about the process; and Epic tools that make it easier to document and track conservatorship-related information.

“Our goal was to develop an efficient, health system process that creates a single standard of care,” said Patricia Babcock, RN, director of YNHHS Care Management. “More importantly, by reducing unnecessary lengths of stay, we’re ensuring that our patients receive the level of care they need in the most appropriate settings and improving the patient and family experience.”