Successful ED case managers need to be highly skilled with a high level of clinical knowledge, the ability to work quickly, and good organizational skills, says Patricia Hines, PhD, RN, managing director and care management transformation practice lead with Novia Strategies, a national healthcare consulting firm.
ED case managers have to be comfortable working quickly, adds Nancy Magee, BSN, MSN, RN, senior consultant for Novia Strategies. “The volume of patients seen in the emergency department, the need to move patients through quickly, and government regulations all mean that case managers have to work at a more rapid pace than those on the inpatient units,” she says.
Candidates should have the skills to complete a quick assessment of patients, often with less information that they would have on the unit, says Karen Zander, RN, MS, CMAC, FAAN, president and chief executive officer for The Center for Case Management. Former ED nurses and social workers make the best ED case managers, Zander adds.
“The case managers in the emergency department don’t have a lot of time and often they have limited information. They have to be able to make an accurate determination of whether the patient should be admitted as an inpatient, placed as an observation patient, or not admitted at all. If patients can be discharged, they need to be able to quickly organize the services and other resources the patient will need in the community,” Zander says.
“To be effective, emergency department case managers have to have the big picture of what is going on in the entire health system and be aware of the financial implications of the decisions they are making. They need to be knowledgeable about alternative levels of care and treatment venues and be able to link patients to resources in the community,” Hines adds.
Training for the ED case managers and social workers should include a review of the requirements from CMS and commercial payers, including medical necessity criteria, payer authorization requirements, and the Two-Midnight Rule, Magee says.
“They should be able to recognize patients with a high rate of recidivism and link them with appropriate community resources that will ensure a safe transition and help them choose a more effective treatment venue than the emergency department,” she adds.
Magee suggests that new ED case managers spend time with the ED charge nurses to learn the flow of the department and become familiar with what the clinical teams do and how they work.