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Q&A: What is case management's role in quality improvement?

Case Management Weekly, September 22, 2010

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Q: What is case management’s role in quality improvement?

A: Hospital-based case managers traditionally function as the eyes and ears of quality management and performance improvement programs across the continuum of care. They identify clinical quality issues during chart reviews, patient interviews, and interdisciplinary rounds, and generate quality referrals for case review. Examples of some of the most common quality issues identified by case managers include:

• Clinical service delays: unavailable tests/treatments that must be completed in the inpatient setting due to medical necessity
• Adverse events or outcomes: such as medication errors, healthcare-associated infections, physician access or lack of physician visits or orders, and patient/family complaints

As experienced/expert clinicians, case managers facilitate and coordinate the activities of the nursing, medical, and ancillary staff as they monitor patient progress and outcomes. They are aware of the “big picture” of the patient’s story, as well as the expected plan of care and desired outcomes.

This week’s question and answer is adapted from Emergency Department Case Management: Strategies for Creating and Sustaining a Successful Program, published by HCPro, Inc. For more information about this book or to order your copy, visit the HCMarketplace. 

Do you have a question about a case management topic? Send it to Associate Editor Ben Amirault at bamirault@hcpro.com. An answer to your question might appear in a future issue of Case Management Weekly.

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