Survey survival secrets lie in paths, documentation
Demonstrating quality across the continuum
Case management is quickly becoming an area of interest to the Joint Commission on Accreditation of Healthcare Organizations as an accrediting factor for meeting the continuum of care standards -- and that can be a good thing, say case management directors who recently have been through the survey process.
In fact, your critical pathways and cross-continuum documentation may be the keys to making your department shine during a survey, if you can show that you have all the right program components in place.
Mercy Medical Center in Rockville Centre, NY, apparently did have the right components in place when the Oakbrook Terrace, IL-based Joint Commission surveyors recently paid it a visit, says Lois Fink, RNC, MA, director of nursing services, the department that oversees the hospital's case management program.
"There is now a whole chapter on the continuum of care, and we are very involved with the continuum here. The surveyors looked at our whole process of assessment and reassessment, which includes our multidisciplinary approach to collaborating on the patient's plan of care right from admission through discharge. They were impressed with our referral process within the disciplines and the communication between the disciplines," Fink says.
Don't break the chain
That link between the disciplines is exactly what the Joint Commission wants case managers to demonstrate. That's because the Joint Commission is moving toward a performance-focused accreditation whereby caregivers provide seamless patient care from one discipline to another, explains Richard W. Scalenghe, RMT, associate director of the department of standards. "We can't write standards directed to the quality of care, but we can look at the performance. We have refocused the standards to meet how health care is delivered, and we are looking to outcomes to measure quality of care," Scalenghe says.
Scalenghe adds that for 1996, all chapters from sections one and two of the Joint Commission's standards are relevant to case managers.
The 1996 standard CC 2.1 has not changed from the previous year. Specifically, here is what the Joint Commission is evaluating within its continuum of care standards that affect case management:
* processes for facilitating access to the appropriate level of care based on assessed needs;
* acceptance criteria for entry based on outcomes assessment;
* criteria that define the essential information needed to determine appropriateness for entry;
* the entry process, which should include a mechanism for the patient/family to receive information regarding care;
* continuity over time among assessment, diagnosis, planning, and treatment phases;
* process for coordination;
* process for referral, transfer, or discharge based on patient needs;
* discharge process, which should provide for continuity of care based on patient needs;
* process to exchange appropriate information.
Case managers also should have plans in place for recommending alternative discharge options to patients if payment or care is denied by an external agency, according to standard CC 2.1.
In addition, be ready to answer questions such as:
* How do your processes provide continuity over time among the entry, assessment, diagnosis, planning, treatment, and transfer or discharge phases of service?
* How do your processes provide for coordination among the health professionals, services, or settings involved in patient care?
Use the Joint Commission standards as you design -- or redesign -- your case management program to ensure your program is on the right track. "We had Joint Commission last June, and at that point, we were still designing the case management program, which we implemented last fall," explains Christina Maud, RN, administrative director for care management resources at Overlook Hospital in Summit, NJ.
That experience helped Maud more efficiently complete the design of her case management program. "It was the coordination-of-care piece that really stood out for us -- aside from the fact that we wanted to coordinate well to avoid rework and provide quality. We got much more focused on 'What are the processes for doing this?' and 'What are the systems in place to support coordination of care?'" says Maud. "We looked at those procedures among the physicians, the nurses on the unit, the case managers, and the social workers."
Although Duane Price, RN, case manage-ment coordinator at St. Joseph's Hospital in Asheville, NC, has been through his share of Joint Commission surveys, he has not yet experienced one in his role as a case manager. When the day comes, however, Price says the hospital's 35 critical pathways should ensure his department is prepared.
Most hospitals that use critical pathways typically have good experiences with the Joint Commission, says Price, because "that's an obvious way to show the integration of care. The case managers are people they oftentimes want to talk to because they deal with care across the continuum, and the Joint Commission standards are now written to deal heavily with integration," he observes.
Surveyors may want to join your meetings
When preparing for a Joint Commission visit, Scalenghe advises case managers to look at all of their processes that pertain to access, assessment, patient/family education, discharge planning, and how the patient moves through the hospital's health system. He also suggests reviewing the processes you use for follow-up after discharge, and to be prepared to show how communication is relayed and ensured between settings.
Fink shared the following tips that helped to make her Joint Commission survey successful:
* Conduct interdisciplinary meetings.
Surveyors were even present during one of the meetings, talking with staff one-on-one about their individual roles in the patients' care, she says. "They asked, 'How are you participating in the care of the patients?' They pulled charts and records from social work to home care to physical therapy. They asked what that staff member's involvement was, where was it documented, and how was it communicated to the rest of the team," Fink explains.
Interdisciplinary groups a must
In addition to the case managers, social workers, home care nurses, physical therapists, and "any other disciplines that we feel are necessary, depending on the type of unit we are discussing, are present at these meetings," Fink says.
During the weekly meetings, individual patients are discussed, care plans are mapped out, and critical pathways are reviewed.
"If you have not gotten interdisciplinary groups together to discuss patient care, you should. These meetings were probably the biggest strength that the surveyors observed in our hospital functions because the surveyors saw open communication among staff, making all staff aware of what was going on with the patients on the unit," Fink stresses.
* Design pathways to cover the continuum.
In turn, the interdisciplinary meetings also serve as an educational forum to teach staff how to use and document the critical pathways. All of Fink's pathways address the entire continuum, including social work and home care. "Everybody has started getting involved documenting [with the pathways]," Fink says.
* Develop an interdisciplinary communication tool.
As a quality improvement strategy, Fink and her staff developed a discharge planning worksheet, created just prior to the Joint Commission visit. That form is used as a documentation tool, detailing the patient's care plan and explaining which discipline is the primary department involved in coordinating the patient's care.
"So although case management oversees it all, if, for example, we are faced with a definite placement problem, then we know social work is going to be the one managing that patient. They were impressed with that whole piece because it was clearly put in the chart and not mixed up with everything else. This made the process appear seamless to them, and that's what they liked," Fink explains.
* Include a community resource/discharge planning summary.
Also included in the patient's paperwork is a community resource summary or a discharge planning summary. That form summarizes the patient's care plan, and upon the patient's discharge, the patient signs off on that care plan and receives a copy for his or her records, "so the patients know exactly what their plan is," Fink says.
Singling out case management during Joint Commission surveys is still fairly new. "In the past, [case management] was lumped into the discharge planning process, but now, the surveyors have become more educated on case management. So they were very interested in hearing how we coordinate the care, how we interact with other disciplines, whether there is overlap in the services, whether there are issues that we should look at for redundancy, how we are helping reduce LOS, and how we are educating the patients," Fink says.
"They focused on areas like that, and that's how they saw case management being the pivotal point," Fink adds. *
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content