Hospital Case Management – April 1, 2009
April 1, 2009
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Get patient status correct up front to avoid financial repercussions
As hospitals experience an increasing number of audits for medical necessity of admission, it's more important than ever to make sure that patients are in the appropriate status and that the medical record contains the documentation to support the status, says Deborah Hale, CCS, president and CEO of Administrative Consultant Services LLC, a health care consulting firm based in Shawnee, OK. -
What's appropriate for observation?
According to the Centers for Medicare & Medicaid Services (CMS), observation services are "a well-defined set of specific clinically appropriate services, which include ongoing short-term treatment, assessment, and reassessment." -
Status determined before bed assignment
Before a patient at Christus St. Vincent Regional Medical Center is registered or assigned to a room, a utilization review nurse in the hospital's Patient Intake Center reviews the patient's clinical information and collaborate with the admitting physician to determine that patient's status. -
Critical Path Network: Six Sigma project improves documentation of patient status
A Six Sigma project to improve documentation of patient status has resulted in increased satisfaction, increased productivity, and decreased denials for Medicare reimbursement for Virtua Health, a four-hospital health system in southern New Jersey. -
Critical Path Network: ED slashes average wait time by more than an hour
No ED cuts its average door-to-doc time from 93 minutes to 20 minutes by accident. The success story at Memorial Hermann Memorial City Medical Center in Houston was the result of discovering a patient flow model at another facility that was superior to theirs, and then continuing to search out additional models to come up with their own system that best addressed their specific needs. -
Critical Path Network: ED's turnaround time cut by almost 30 minutes
By implementing a Lean process change that it calls TAPP (Team Assessment Pull Process), the ED leadership in the Children's Healthcare of Atlanta system has realized a 25-minute reduction in median overall turnaround time, from 192 minutes to 167 minutes, excluding its fast track. -
Critical Path Network: Break down these barriers to medication safety
A patient's chart is unavailable. Verbal orders are not yet written in the patient's chart. The identification bracelet is not yet on your patient. These are three reasons that an ED nurse may fail to comply with one of The Joint Commission's National Patient Safety Goals (NPSGs): the requirement for use of at least two patient identifiers. -
RNs, LCSWs cross-trained to work as case managers
When Brookhaven Memorial Hospital Medical Center redesigned its case management function, merging the social work, utilization review, and clinical guidelines departments, the hospital cross-trained staff in all three departments to handle case management functions. -
Palliative care gets patients to right care level
At Summa Health System, hospital case managers, called patient care coordinators, often are the first people to alert the palliative care team when a patient could benefit from a consultation and the first people the team contacts to find out what's going on with a particular patient.