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Community Case Management

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  • How Case Managers Can Help Victims of Trafficking

    Case managers can learn skills and tactics for helping patients who have been trafficked. For example, investigators used an online training module to educate ED staff about human trafficking. Participants reported more confidence in identifying a possible human trafficking victim, noting they were more likely to screen patients for human trafficking.

  • Stroke Patient Navigator Prevents 30-Day Readmissions

    A stroke nurse navigator team can prevent 30-day readmissions in stroke patients treated with thrombolysis, investigators found. A health system’s 30-day readmission rate was 13.6% before it began to use a stroke nurse navigator. The rate declined to 6.9%. Patients with the stroke nurse implementation were 67.6% less likely to be readmitted within 30 days compared to patients without the navigator.

  • International Discharges Create Chaos and Inspire Creativity for Case Managers

    Case managers and discharge planners in every state sometimes encounter the most challenging and frustrating of cases: the international discharge. Hospital Case Management asked Judith R. Sands, RN, MSL, BSN, CPHRM, CPHQ, CCM, ARM, a clinical consultant and author of Home Hospice Navigation: The Caregiver’s Guide, to answer a few questions about best practices in handling these unique care transition cases.

  • Care Coordination and Communication Needed Between Transplant Providers and Primary Care

    Cirrhosis affects a small percentage of the U.S. population. But it is a highly complex disease that leads to high hospital readmission rates and a higher cost per patient than found in heart failure and COPD. Investigators found care coordination and efficient communication between providers can optimize care. Telehealth can help patients, particularly for return visits.

  • Case Management Challenges in the Emergency Department

    Hospital case management already is unique. But carrying out this role in the ED brings even more challenge and intensity to bear. It also affects operations and well-being in the rest of the hospital.

  • For Clinicians, Discharge Safety Is a Growing Ethical Concern

    More often, clinicians are asking ethicists questions such as, “Is this discharge plan ethical?” It seems clinicians are distressed over what they consider to be unsafe decisions. Clinicians create a treatment plan based on what they believe is in the patient’s best interest. For various reasons, sometimes the plan is just not feasible.

  • Multidisciplinary Initiative Leads to More Referrals, Donors, and Transplanted Organs

    Staff training and more visible public awareness helped a Georgia hospital make tremendous improvements.

  • For Clinicians, Discharge Safety Is a Growing Ethical Concern

    Clinicians are asking if a discharge is plan ethical, indicating distress over what they consider to be unsafe discharges. Healthcare providers create a treatment plan based on what they believe is in the patient’s best interest. For various reasons, sometimes the plan is just not feasible.

  • Ethical Discharge Planning for Victims of Violence

    Decision-making in these cases always is going to be somewhat subjective. Physicians must rely on clinical judgment, along with available resources and information. What is important is to make the decision using an ethical framework.

  • Community Members Help Train Research Staff

    At Tufts Clinical and Translational Science Institute, research staff learn how to provide informed consent by working with community members acting as simulated prospective study participants in role-playing exercises. More than 40 community members, researchers, patients and families, and healthcare providers offer feedback and help develop training.