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A woman who suffered from long-standing depression presented to the hospital seeking an adjustment of her antidepressant medication. During hospitalization, she suffered seizures. The hospital was unable to determine the etiology of the seizures and transferred the woman to another hospital in the area. Upon transfer, she underwent an examination and laboratory testing.
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A man slipped and fell while getting out of his hospital bed, causing him to suffer a fractured hip and leg. The man and his wife sued the hospital for negligence, claiming that he had not been fitted with "gripper socks" and that nurses had not responded after the man had attempted to call them with the call light.
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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.
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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.
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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).
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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.
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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.
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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.
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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.
