Case Management

Experts take on ED case management questions

Case Management Insider, April 28, 2015

The emergency department (ED) case manager has a number of critical functions in any hospital. During HCPro’s February webcast “Emergency Department Case Management: Manage Challenging Patients and Special Populations,” speakers talked about the challenges ED case managers face and the important role that they play.

The webcast was presented by Karen Zander, RN, MS, CMAC, FAAN, president and owner of The Center for Case Management in Wellesley, Massachusetts, Lisa Gawle, RN, BSN, an ED nurse case manager at a level 1 trauma center in western Massachusetts and consultant for the Center for Case Management, and Heidi Rohloff, RN, MSN, ACNP, an ED nurse practitioner in Detroit, MI and consultant for The Center for Case Management. Following the presentation, the speakers fielded some questions from participants. (See related story in the May issue of Case Management Monthly.) Below, we summarize some of the questions and answers from the presentation:
Q: Should case managers play a role when it comes to clinical documentation improvement (CDI) in the ED?
A: Case managers do play an important role in supporting physician documentation in the ED. Physicians definitely need guidance when it comes to ensuring they include all the information needed for successful billing and patient care. Case managers are already focused on InterQual® and Milliman® criterion so they can definitely contribute to this knowledge. A goal should be to, in some way, combine the utilization review and CDI function in the ED to improve this documentation. You may not necessarily need a special CDI person in the ED full time; you may consider using the same person who is already looking at InterQual and Milliman guidelines to guide observation and inpatient decisions, provided they get additional CDI training.
Q: Should ED case managers collaborate with bed managers to ensure correct patient status when admitting patients to the ED?
A: Yes. It’s really important for organizations to ensure that patient status is correct, right from the point of entry—which in a lot of cases is the ED. Case managers can really collaborate with the bed manager to ensure correct patient status whether observation or inpatient. If you don’t’ get it right off the bat, it’s a huge headache to go back and correct the problem on the backend by issuing a condition code 44. Collaboration between the bed manager and case manager should include an educational component to guide these decisions. Some hospitals are increasingly teaming up case managers and bed managers for better results in this area.

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