Reorganization improves efficiency, cuts LOS

Case management is a three-pronged approach

Following a comprehensive redesign of its case management department, the average lengths of stay (LOS) on some medical services at the University of Alabama in Birmingham (UAB) Medical Center’s University Hospital have declined. For instance, the average LOS for the trauma patient population has declined by one day, while the average LOS for the burn patient population has dropped by three days.

"The UAB case management process was restructured two years ago by a design team that identified how the various disciplines could work together to better manage patients," says Donna R. Lawson, MSHA, MBA, director of quality and care management.

The hospital takes a triangular approach to case management. The core members of the team include master’s level registered nurses (RN care managers) who handle clinical care coordination and clinical resource management; social workers who deal with psychosocial needs of the patients, and execute discharge plans; and licensed practical nurses who handle telephonic utilization review.

"This core team works closely with the physicians, ancillary departments, and bedside nurses to expedite the patient’s transition to the next level of care, ensure appropriate clinical resource usage, and facilitate payment for services provided," Lawson says.

The role of the RN care managers changed the most following the redesign. They monitor the care plan and intervene as necessary to make sure patients receive the services they need in a timely manner.

"The RN care manager is the one constant person who deals with each patient. The patient may have several nurses during the course of their stay, but the RN care manager sees that person from beginning to end," Lawson says. For instance, the RN care managers in the trauma/burn service are on call 24 hours a day, seven days a week. Whoever is on call has an alert pager that notifies him or her when a trauma patient enters the emergency department (ED). Those care managers respond to every trauma alert and begin their involvement when the patient arrives in the ED.

They make daily rounds with the clinical team and coordinate a weekly multidisciplinary case conference to review the patient’s progress and make sure the patient is moved through the acute care facility to the next level of care in a timely manner. They also work with the social worker to identify what the patient is likely to need after discharge.

The trauma/burn care managers attend follow-up clinic twice a week to see their patients after they are discharged from the acute care hospital.