The NICU/PICU Case Management Experience
While many departments and practices within the medical field might entertain a shift toward a more family-centered care model, no place exhibits this more than neonatal intensive care units (NICUs) and pediatric intensive care units (PICUs). Care for these patients must include family, and so differs somewhat from case management in adult populations.
Social Work Is Half the Battle
Families of children in the NICU/PICU might require more social work resources. Care also might be more time-consuming than is seen in other units.
“In the NICU, you’re dealing with families when they’re in crisis mode and overwhelmed,” says Kathy Brancely, RN, CCM, RN care manager in the NICU/Continuing Care Nursery at Maine Medical Center. “Social work is critical at that time, especially when they are unsure if their child will survive.”
Brancely also notes it is vital for the social work case manager “to be in tune with insurances,” as parents with a child in the NICU/PICU often cannot go back to work — and sometimes lose their jobs.
While most case managers conduct assessments for their patients early in their admission, Jennifer Boone, LCSW, social work care manager in the NICU/Continuing Care Nursery at Maine Medical Center, explained that early assessment is a must in the NICU.
“We see every new admission, every family, within 24 hours,” Boone shares. “After the trauma that they may have had after having the baby, we need to find out what needs the family may have and follow through with mental health support, social determinants of health, and sometimes also with the Department of Health and Human Services regarding substance-exposed infants.”
For NICUs and PICUs that are part of a major hospital system, the social work case manager and the case management care team also help families find temporary housing near the medical center.
“We often have families who come from six to eight hours away, so social work helps them with the stressors around finding housing,” Boone says. “Some families are able to stay at the Ronald McDonald House, but not all.”
Differences in Discharge Planning
Often, babies in the NICU are born prematurely and with low birth weight, leading to other medical issues that need attention by physicians and case management staff.
“Low birth weight babies often qualify for low birth weight SSI [Supplemental Security Income], so the case manager has to stay on top of each infant’s possible eligibility” Brancely explains. “Unlike the adult inpatient units, our discharges are a bit different because we need to focus on the growth and development of infants.”
Brancely notes most of the babies in the NICU require services to be arranged by the case manager.
“Most get some types of home care referrals, whether its developmental services at home, sending infants home with oxygen or ventilators, and even private-duty nursing is often approved for babies who require extensive care,” she says. “In rural areas, these services can be more challenging to set up as many resources are less available in the community. It can be especially hard in those places to find a visiting nurse or private-duty nurses.”
In addition to the challenges of making appropriate referrals during discharge planning, Boone also points to the need for finding services for the patient’s family.
“There are considerations with going back to work, with food, lodging, gas prices,” she explains. “Financial barriers are what we come across most often. We work with families with untreated mental illness/substance use and homelessness with their support networks being far from home while in the hospital setting. We always do what is in the best interest of the baby, but there is a lot of work to be done with families. We spend hours and hours with families, just trying to help.”
Critical Communication for Critical Care
Case management teams rely on regular meetings, rounds, and other forms of communication to keep the process running smoothly. In the NICU and PICU, this communication is be even more critical.
On one hand, there is less turnover in the NICU/PICU due to increased lengths of stay, but the census often is higher than in other units.
At Maine Medical Center’s NICU/Continuing Care Nursery, “interdisciplinary meetings [are] set up for once a day, but [there are] other avenues throughout the day also for follow-up.” This frequent communication is essential, as many babies and children often are discharged and transferred out of a major hospital system and into a local hospital closer to home as soon as they are stable.
Thankfully, it is more likely on a NICU or PICU to have quick, easy access to the physicians, Brancely says.
“I know that some adult case managers may find it hard to track down providers when needed. But as an intensive care unit, we have to have access to a physician at all times, so that gives us great opportunities for access,” she adds.
Case managers should exhibit compassion and patience with the families under their care, Brancely advises.
“You truly have to meet the family where they’re at,” she says. “When you first meet them, they’re not the same as what you’ll see down the road because of how stressed out they are at first meeting.”
Working with babies, children, and their families in the NICU/PICU has its challenges, Boone and Brancely explain. But they both reiterate it is an incredibly rewarding place to practice case management.
“You’re making such an impact early on in the child’s life, making such a difference,” Boone says. “You never know what to expect next because every day is an adventure. We’re never bored at work.”While many departments and practices within the medical field might entertain a shift toward a more family-centered care model, no place exhibits this more than neonatal intensive care units and pediatric intensive care units. Care for these patients must include family, and so differs somewhat from case management in adult populations.
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