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CM staff worked hard to get buy-in for redesign
Staff visited physicians, hospital meetings
Before the case management staff at Davis Memorial Hospital in Elkins, WV, went live with its newly designed case management plan, staff worked hard to sell the new arrangement to hospital staff and attending physicians.
Once the plan was in place, case management staff met with the charge nurses who did the bed assignments and explained what they were trying to accomplish and the benefits of giving case management control of admissions.
They spoke at meetings of emergency department staff and day surgery staff. They also made a presentation at the monthly meeting of all the hospital's clinical managers.
"We had a marketing plan that started with those areas. We took some time and didn't just jump into it," says Tod Thorpe, RN, CPC-H, director of case management.
Once they got buy-in from hospital staff, the case managers started attending medical staff meetings to gain acceptance from local physicians and their office staffs.
They scheduled an inservice meeting with the local medical office managers association. The staff put together baskets of treats and visited the physician offices in the area, making a presentation about the new requirement that case management has to preapprove admissions.
In some offices, the case managers met with the physicians; in others, they met with the office nurse in charge of pre-authorization.
"We are in a small area, and although we had a good many to hit, it was nothing we couldn't do," Thorpe says.
The case managers gave each physician office a health resources directory, which is a compilation of referrals and other resource information that all the case managers had collected.
The information is broken out into categories such as ambulance services, transportation services, durable medical equipment vendors, and personal care homes, and is bound in a book with the hospital logo. "When you do a little something for them, it helps a lot to smooth the way," Thorpe says.
All of the case managers at the hospital went through training in assignment of diagnosis-related groups (DRGs) and now assign DRGs on the front end on the open chart.
When the training was complete, case management staff held a dinner for the physicians, explaining the DRG assignment process and how it would make their job easier.
"It takes a lot of interaction from the physician to do this. It helps to have good communications between the physicians and case managers," Thorpe says.
The hospital and physician staff have largely been pleased with the new arrangement, Thorpe says. In fact, the ED director has requested more case management coverage for his area.
"For the most part, we get a lot of compliments on the changes. Our lengths of stay are so short that the quicker we can initiate discharge planning, the better off we are, and the doctors recognize that," he says.