Hospital quantifies workload and caseload
If no case manager is working weekends, there is the potential to have an increased workload on Mondays and Fridays in preparation for a well-coordinated discharge from hospital as well as screening new patients for case management needs, says Lisa Zerull, MS, RN, program director at Valley Health System in Winchester, VA.
"Even within one acute care facility, you will find that caseloads will vary from service to service because the needs of patients will vary," Zerull says. She argues that more staff reviewing the chart often translates into decreased efficiency because of duplication. "Also, the patients are confused about who is truly responsible for coordinating their care," she says.
According to Zerull, the patient and physician preference is to have a clinically focused case manager available on a given unit or service because it provides continuity of care. "If the case managers are required to work in an office using the phone or computer to negotiate coverage for a patient, they are not available to patients and staff in the clinical area."
The architectural layout of a unit also can be an important consideration, she says. "At Winchester Medical Center, the smaller units have 20 beds and the larger units have 40 beds. It seemed a natural choice to have one case manager for up to 20 beds."
When her facility addressed these questions, Zerull says that some case managers thought they could handle many more patients then others. "We actually did a time-engineered study," she reports. "We found great differences between what a case manager on a renal unit does from another case manager on a medical cardiac unit."
The study also looked at other responsibilities of case managers that affect potential caseload. For example. In one instance, a case manager was serving on as many as eight subcommittees.
Zerull has designed a reference table that she says came out of her system asking those questions. It can be used when defining the case manager responsibilities and in determining caseloads. (See table, below.)
[For more information, contact:
- Lisa Zerull, MS, RN, Program Director, Valley Health System, Winchester, VA. Telephone: (540) 536-5344. E-mail: [email protected].]
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