CM is quality central at CA hospital
It’s been a long road, director says
Three years ago, Sandra L. LaRusso, RN, MA, ARM, then a part-time employee at Com munity Hospital of San Bernardino (CA), submitted a proposal to her supervisors laying out an ambitious plan for bringing together almost all of the hospital’s quality-related disciplines under a single case management department. Six months later, the plan was a go, and LaRusso was tapped to head up the initiative. Now the hospital’s director of case management, she’s responsible for a department that controls not just case management, but social work, utilization review, risk management, and infection control as well.
"We recognized that there was some overlap in all these functions," LaRusso says. "There was a lot of duplication and lot of the same people looking at the same medical records, trying to get the same information. So our initiative was based on recognizing that these five functions were interdependent on each other and could benefit from having a close communication link."
While many hospitals have taken steps to bring utilization review and discharge planning under case management, LaRusso contends that it’s natural to consider bringing in risk management as well. "In health care, most of the high-risk kinds of occurrences are quality-related," she contends. "So it’s really important that when these incidents are reported, they go to risk management for liability assessment. But often, the risk management person may not have a clinical background. They may have an insurance or a legal or some other kind of background."
Through her own experience in both quality improvement and risk management, LaRusso has found that in some instances, the proper information doesn’t always filter from risk management to quality management. "The reason for integrating and putting risk in this [case management] was so that occurrences would be evaluated at the same time for both liability and quality issues. And also so we could follow up quicker, because if there’s a delay in getting feedback, you’ve lost your opportunity for early intervention."
LaRusso’s case management department has 27 full-time case managers with various backgrounds. But as time goes on, LaRusso expects that the number of registered nurses on staff will increase. "As folks attrition out, I am replacing them with either RNs or MSW or LCSW social workers," she says. She adds that a number of her registered nurses have or are getting advanced degrees. "I have several who, since I’ve been here, have gone on to get their master’s. We’re attritioning in favor of the higher-degreed and licensed person."
LaRusso notes that achieving integration among five disciplines has been a long haul, and they’re still not completely there. "When I agreed to take this position, I told my administrator that it was a three-to-five-year project. He said, We want to have this done tomorrow,’" she says. "It’s been an educational process to get my boss to understand that this is a major change that takes a long time."
She estimates that the department is now about 70% integrated. Currently, three separate coordinators within the department oversee different functions. For example, quality management and risk management are under one coordinator, while infection control and utilization management are under another. "So, my five departments that I originally started out with, under the umbrella of case management, have really become three," she says. "And ideally, we’ll get to a point where we have one box, and everybody has case manager’ after their name."
For more information about Community Hospital’s case management department, contact:
Sandra L. LaRusso, RN, MA, ARM, director of case management, Community Hospital of San Bernardino, 1805 Medical Center Dr., San Bernardino, CA 92411. Telephone: (909) 887-6333.
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