One of the key factors of measuring compliance for pre-admission screening information and post admission evaluation is the ability to determine the “admission” time. There has been some debate recently that admission is not merely the time recorded in the ADT (admission, discharge, transfer) system generally held in the demographic data base of record, but officially it is recorded at the time the physician signs and dates the orders once the patient enters the rehabilitation facility/unit.
Because there seems to be such focus and interest in knowing what is the correct time, I asked this question of Susanne Seagrave, Inpatient Rehab Team Lead, CMS/CMM/CCPG/Div., of Institutional Post Acute Care recently while attending her discussion on “CMS Update on Coverage Criteria for IRF’s and IRF Current Policy and New Initiatives”, AMRPA Conference, Miami, FL., Sept. 28, 2011.
Susanne informed all that the intent of the the admission definition was to capture the time the patient arrived on the unit and was expected to be cared for by the IRF staff. That time should be reflected in the documentation and it is NOT the time necessarily that a physician writes the order unless the patient arrives and orders are written simultaneously.
I think most facilities agree that there are generally standing orders and transfer orders that initiate the on-site plan of treatment. Often physicians will provide verbal clarification of those admission orders and sign off in person within a time frame acceptable to the policies of the facility.
These types of influences in tracking the time admit orders are authenticated would make it difficult to count both the 48 hour preadmission assessment concurrence and approval of admission and the 24 hour H&P and post admission evaluation paper work completion. It is not difficult however to observe the patient enter the unit and track the actual time of arrival so that the electronic system of record accurately portrays the time the IRF accepts responsibility for the care of the patient.
If this is a time you doubt in your system, it is worth validating process and practices to be sure the time of record is as closely accurate to the time of arrival as possible. Sloppy practice of data entry hours after a patient arrives may have unintended consequences; although it was confirmed again by Susanne that technical denials is not the focus of this stringent time frame. On the contrary, it is specifically to have the most current information available both prior and just after admission (physical appearance to the unit) so that the patient receives the quickest physician led plan of care that leads to discharge and goal attainment success.