A phone call is worth a thousand documents

Talk to the next level of care

The problems of the world could be solved if people just talked to each other, BK Kizziar, RNC, CCM, CLCP, a case management consultant based in Southlake, TX, asserts. And that statement definitely applies to case managers as they hand off patients to clinicians at the next level of care, she adds.

"It may be easier to e-mail a document or send a text message, but nothing beats taking the time to pick up the telephone and talking to the provider who is taking over the care of a patient," she says.

Case managers in all settings need to communicate across levels of care to make sure that everyone has the whole picture of the patient, Kizziar says.

"Case managers may say they don’t have time for the phone calls, but lack of communication with the next level of care is going to come back to haunt us with readmissions and poor outcomes. In addition, that is not the attitude that a patient advocate would take," she says.

Telephone communication gives the receiving case manager a chance to ask questions and gives the case manager who knows the patient a chance to share information that doesn’t get into the patient record. "There may be nuances about the patient’s health and family situation that a case manager wouldn’t feel comfortable in writing down but that will help the staff at the next level of care meet the patient’s needs," she says.

"Nobody has the whole picture of the patient. We all need to be communicating with each other and doing so in the most effective way," she says.

When patients are discharged from the hospital or another facility, case managers typically take care of the paperwork, then move on to the next case, Kizziar says. "Rarely have I seen hospital case managers call the next responsible party and give them a discharge report. Standards of Practice require us to give pertinent information to the next person handling the case, and we have failed miserably. We are so dependent on electronic transmissions and material copied and stuck in an envelope that it never occurs to us to communicate verbally, and that’s where patients fall through the cracks," she says.

People in healthcare tend to operate in silos, adds Catherine M. Mullahy, RN, BS, CRRN, CCM, president and founder of Mullahy and Associates, a Huntington, NY, case management consulting firm. "They work with a patient during one episode but don’t hand the patient off to the next level of care. High-cost, complex patients don’t stop being that way because you can’t see them. You have to talk to the case managers at the next level of care," she says.

In addition to providing details on medical treatment and medication, case managers should give their counterparts at the next level of care information about the patient’s family/caregiver situation, what happened during the hospitalization, and the patient’s challenges. "Otherwise, it’s just a discontinuation of services and not a real transition," she says.

Kizziar advises health plan case managers to reach out to their counterparts at hospitals, physician practices, and other settings to find out exactly what is going on with the patient and collaborate on planning the care. "You can’t get a clear picture just by reading a document. Often if case managers speak to someone about the patient’s situation, it can change their perception of the case," she says.

"I saw that when I worked on the insurance side. The documentation might lead me down one path, but if I called and talked to the case manager who had been working the patient, sometimes I would be more inclined to go in another direction," she says. n