CM is the glue holding the trauma team together

Duties include coordinating care, helping families 

The trauma team at Borgess Medical Center in Kalamazoo, MI, refers to Dorothy Malcolm, RN, BSN, as "the glue that holds us all together." As trauma case manager, Malcolm coordinates care for trauma patients from the time they come into the emergency department (ED), during their entire stay in the hospital and while they are being treated in the outpatient follow-up clinics.

"My job entails making sure the patients and their families needs are met and coordinating with the multidisciplinary trauma teams to ensure that all bases are covered," she says.

She coordinates care for traumatically injured patients, no matter what unit they are on. The hospital also has care managers, assigned by floor, who handle traditional case management duties such as discharge planning, utilization review, and coordinating with the insurance company.

Malcolm works with the care managers in the critical care units and on the neurology and orthopedic floors, coordinating the care of their traumatically injured patients.

"As a team, care manager, trauma case manager, and medical social worker, we can meet with the families to answer their questions. The care managers deal with the insurance piece and may bring up real questions for families in regards to different facilities and equipment. This gives us an opportunity as a team to explain the differences in facilities, what they have to offer, and what might work best for the patients and their family," she explains.

Malcolm coordinates all the clinical needs of the trauma patients and usually carries a caseload of 15 to 20 patients. She attends rounds with the multidisciplinary treatment team each day and helps develop the plan of care and the patient’s treatment plan for the day.

Covering the bases 

Following rounds, Malcolm makes a list of what each patient needs that day. She coordinates with members of the trauma team to make sure everything that was discussed happens.

"I’m the team captain, making sure each person on the team has covered their base, keeping the plan of care on track," she says.

Malcolm works from an office in the critical care unit and is paged along with the rest of the team when a patient comes into the ED.

"If I am in the hospital, I report to the emergency room almost every time. I’m usually the scribe nurse in the trauma room. If the family is available during the resuscitation of the trauma patient, I make contact with the family to provide them with some initial information and to let them know that the physician will see them when he or she can get away. It gives them a little bit of relief that someone has come and talked to them, and it also gives them a face they will see again during their loved one’s hospital stay as I will attempt to meet with them on a daily basis." she says.

Communicating with, educating patients 

Meeting with families and helping them understand what the patient’s injuries and potential outcomes after discharge is a major component of Malcolm’s job.

"I make every effort along with the other people on the trauma team, such as medical social work and pastoral care, to facilitate not only patient care needs but also their families’ needs, whether it’s housing at our hospitality house, help with insurance paperwork, or just a shoulder to cry on," she says.

Malcolm meets with the families sometimes on a daily basis, giving them updates on the patient’s condition, the plan of care, and what outcomes they can expect. She talks to them about discharge options and educates them on what to expect if the patient is discharged to a rehab center or skilled nursing facility.

"Families with a critically injured loved one see so many people who bombard them with information. I’m the one person they see Monday through Friday. I give them a face and a name to go to for information," Malcolm adds.

As the patient progresses, she coordinates family meetings with the trauma surgeon, neurologist, neurosurgeon, social workers, or other appropriate members of the care team.

Later, Malcolm visits with the families to make sure they understand what is going on with the patient and helps them begin the coping process. "It’s really hard for family members and patients to understand everything that is happening. Sometimes, they can be told the same information from three or four different disciplines, but they hear and understand different pieces from each conversation. That is why family meetings are so important. We try to treat people like they are our own family, being honest, open, and realistic," she says.

Malcolm sees all of the patients who are on the trauma service daily, even those who are in the hospital only a few days, encouraging them to call her if they have any problems after discharge and before they come to the follow-up clinic. Giving the patients someone to call with questions helps cut down on readmissions, she explains.

Following up with patients 

Malcolm follows up with the patients when they come into the trauma services clinic after discharge making sure they have made other follow-up appointments with whatever specialists they need to see.

When Malcolm comes into the hospital each day, she gets a list of new trauma patients from the hospital’s computer system and then accompanies the trauma team on rounds.

"I attempt to see every patient prior to trauma team rounds or access their information to look at their last 24 hours in the hospital. This information is helpful in rounds when we are looking at progressing the patient’s plan of care. For instance, I look for information on where they live. As we look at discharge planning, we want to place the patients close to home if that is their preference," she says.

Malcolm meets with the patients and families throughout the day, giving them updates on what is going on.

If a patient is being discharged, she makes sure they have prescriptions, discharge instructions, and other things they need.

If the patient is being transferred to a rehabilitation hospital or nursing home, Malcolm assists in getting the records transferred and assembles X-rays and other items that go with the patient.

She follows the patients through the hospital stay and while they are being treated as an outpatient, working with the team in the trauma service clinic, where patients come for outpatient care and follow-up after discharge.