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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.
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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.
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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.
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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.
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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.
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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.
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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.
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According to the Centers for Medicare & Medicaid Services (CMS), observation services are "a well-defined set of specific clinically appropriate services, which include ongoing short-term treatment, assessment, and reassessment."
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Before a patient at Christus St. Vincent Regional Medical Center is registered or assigned to a room, a utilization review nurse in the hospital's Patient Intake Center reviews the patient's clinical information and collaborate with the admitting physician to determine that patient's status.
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No ED cuts its average door-to-doc time from 93 minutes to 20 minutes by accident. The success story at Memorial Hermann Memorial City Medical Center in Houston was the result of discovering a patient flow model at another facility that was superior to theirs, and then continuing to search out additional models to come up with their own system that best addressed their specific needs.
