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Discharge Planning Advisor
CCM staffing model has 'general guidelines'
UR, CC, DP functions combined
With increasing demands on case managers' time and expertise, many professionals believe a reevaluation of staffing ratios is in order. The fact that staffing models vary significantly among hospitals complicates the issue.
Karen Zander, RN, MS, CMAC, FAAN, principal and co-owner of the Center for Case Management in South Natick, MA, was one of several case managers who discussed the subject in the April 2007 issue of Discharge Planning Advisor.
Zander has designed a staffing model (see chart) that offers general guidelines for the combined responsibilities of utilization review, care coordination, and discharge planning.
"These are total caseload numbers," she points out, "which does not mean that the case managers or social workers do something major for each of these patients each day. In fact, the process of determining which patients need which services and at which points in the day and/or the stay is extremely important, but often not consistent and certainly not taught well.
"I call it 'fluid reprioritization,'" Zander adds, "because it is much more time-sensitive and multifactorial than traditional [linear] time management methods."
She emphasizes that the guidelines refer to each case management full-time equivalent.
"For example," Zander explains, "if the case manager is only doing concurrent reviews, or the social worker is doing all the discharge arrangements for every patient, then the case manager can handle more patients than shown on the chart.
"On the other hand," she continues, "if the case manager is assigned to physician services rather than units, the organization will need more case managers to cover all the services."
The ranges stated are dependent on many variables, Zander says, such as automation, payer mix, the organization's relationship with key physicians, and whether continuity of care is a priority of the nursing department.
(Editor's note: Karen Zander may be reached at KZander@cfcm.com.)