Emergency department prioritization for case managers

The hospital ED is perhaps the only local institution where professional help is mandated by law, with guaranteed availability for all persons, all the time, regardless of program.

—James Gordon, MD, MPA

The emergency department (ED) should be considered a patient unit, and the case manager and social worker should triage throughout the day. Frequent utilizers of an ED have been an issue for many years, and there are many reasons for this occurrence, from lacking a primary care provider to the perception that there is better access to pain management in the ED. Case managers and social workers play a central role in leading to better outcomes. They must work to improve patient flow in the ED and provide better quality of care for the patient.

A good care plan can shift the frequent flyer parading.

—Michael Silverman and J.J. Sverha, MD

The goal is to identify patients who frequent the ED and ensure that they have a care plan that addresses their needs. Such a plan could be as simple as getting the patient into a primary care provider to create a pain management plan. Case managers and social workers are essential in following these patients to ensure that they can successfully implement and/or participate in the plan.

Following up after an ED visit has become key to preventing patients from returning to the ED when they don’t truly require these services. In ambulatory clinics, case managers are often following up with patients the day after the visit.

Priorities Within the Role

As case managers and social workers prioritize their responsibilities in the ED, they must turn their attention to both patient flow challenges in the ED and hospital capacity. The following responsibilities are key to keeping patient flow moving:

• Identifying patients who may need a discharge plan from the ED to prevent hospitalization
• Reviewing cases determined appropriate for observation or inpatient care to ensure appropriateness

For more information, see Care Transitions in Case Management. Need expert advice? Email your questions for consideration in the Revenue Cycle Daily Advisor. Note: We do not guarantee that all questions will be answered.