Hospital Case Management – June 1, 2009
June 1, 2009
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Track your outcomes to justify adding new staff, avoiding budget cuts
As more hospitals plan staff cuts due to the poor economy and tighter restrictions on reimbursement by the Centers for Medicare & Medicaid Services (CMS) and commercial insurers, case managers are challenged with determining how to demonstrate how their department positively affects the hospital's bottom line and to justify hiring new staff or avoiding staff cuts. -
Use data for operational changes, quality
Case management outcomes can be a powerful tool for identifying the need for operational changes or process improvements throughout your hospital, as well as demonstrating the value of case management. -
Pre-admissions screening helps cut readmission rate
A pre-admission screening and educational program for patients having elective surgery has helped slash readmissions among patients treated at Geisinger Health System from nearly 20% a year ago to about 10% today. -
Critical Path Network: Culture change turns hospital system around
A few years ago, Christus Santa Rosa Hospital in San Antonio was $80 million in the red and was compliant with medical necessity and appropriateness of care criteria only 62% of the time, according to audits by the hospital's quality improvement organization (QIO). -
Critical Path Network: Patient intake center operates 24-7
Every admission to any of the four facilities in the Christus Santa Rosa health system goes through a central patient intake center where RN case managers screen for medical necessity and appropriateness of care and determine patient status. -
Critical Path Network: Pre-op initiatives aid discharge planning
One patient who was attending a preoperative class for joint replacement patients at Geisinger Health System joked that he was being discharged before he ever got to the hospital, recalls Trisha Whispell, BSN, MSW, ACS, social work care manager, who, with her RN care manager partner, presents a pre-admission class on joint replacement and manages care for patients after surgery. -
Surg patients pre-screened for discharge issues pre-op
By the time the majority of patients having elective surgery are admitted to Geisinger Health System, the care managers who will coordinate their care after surgery already have the information they need to create a discharge plan. -
Ambulatory Care Quarterly: Diversion scheme draws national organizations' ire
Several EDs across the country have initiated policies to encourage patients who don't face "true" emergencies to seek care elsewhere in the community and to find "medical homes," but none have been met with the outrage that descended upon the University of Chicago Medical Center recently. -
Ambulatory Care Quarterly: Hospital's plan — a bridge too far?
While it's true that many hospitals and EDs have instituted policies that seek to encourage nonurgent patients to find other medical "homes," the policy recently adopted at the University of Chicago Medical Center goes a bit farther than most, says Sandra Schneider, MD, vice president of the American College of Emergency Physicians. -
Ambulatory Care Quarterly: Beware of EMTALA, warns legal expert
Hospitals and EDs that institute policies similar to the recent approach instituted at the University of Chicago Medical Center would do well to consider that they may be in violation of the Emergency Medical Treatment and Labor Act (EMTALA), warns Michael Frank, MD, JD, FACEP, FCLM, general counsel and director of risk management for Emergency Medicine Physicians (EMP) Management Group in Canton, OH. -
Ambulatory Care Quarterly: 'Seniors-only' ED draws raves from patients
The senior emergency center at Holy Cross Hospital in Silver Spring, MD, may be a rarity, but based on the responses of patients and staff not to mention our increasingly aging population perhaps more EDs should consider creating a separate unit for older patients. -
Ambulatory Care Quarterly: Multi-unit team designs senior ED
Once the decision was made in July 2007 to create a senior emergency center at Holy Cross Hospital in Silver Spring, MD, Bonnie Mahon, RN, BSN, MSN, senior director of medical, surgical, and senior services, put together a team that included two ED physicians, the chief nurse, the nurse manager, and a director of case management. -
Ambulatory Care Quarterly: ED staff volunteer for senior center
Most of the staff in the new senior emergency center at Holy Cross Hospital in Silver Spring, MD, came from the main ED, says David Cummings, RN, CEN, the hospital's emergency center director.