Q&A: Case Management Workload

Q: Our hospital was already informed our budget won’t allow hiring additional case management staff to help with discharge planning and other tasks. I think we can manage evaluating the inpatient and observation patients, but we have a busy same-day surgery unit and emergency department (ED). Do you have suggestions to meet the requirements to evaluate all those patients who have sedation and the ones who need to be seen in the ED?

A: So with the patients that need to be seen in the ED, you may already have some staff that are working in the ED. If you have that patient or that staff already, then use them to see those patients that the doctors are asking for an evaluation, an assessment and use them perhaps also to see patients in the same-day surgery unit, especially those that might be finishing up their surgery late in the day.

There are Conditions of Participation (CoPs) for surgical services in hospitals that identified that all patients must be seen; it mentioned patients who have sedation or patients who undergo invasive procedures. So if you go Google and say conditions of participation for surgical services, they will list those procedures which should be your priority to look at and also knowing that many outpatient surgery patients are planned procedures.  Work with the admitting people that call the patient and get that in writing, talk to them about what are you going to do after you're home. We usually ask, “Who is picking you up?”

I would also look at collecting—if you have been told you're not getting more people, show them the proposed discharge planning CoPs. Outline what you can do. Check your own readmission rates by patients who were referred to SNFs and determine whether that was the right place to send them.

Remember that the discharge planning CoPs don’t say case management has to do everything. The same-day surgery patients that are going to go home, they get a call from a nurse and it doesn’t have to be a case management nurse who does the assessment. Talk with the nurse who calls to do the assessment when the patient is coming in and see if he or she can add a few more questions that will then satisfy the requirements for an assessment for these CoPs and then those patients who need a more in-depth assessment. They're calling case management for those patients anyway for us to see when they come in.

This question was adapted from the HCPro webcast "Discharge Planning: Realignment of Standards and Workflow" featuring Jackie Birmingham, RN, BSN, MS, CMAC, and Janet L. Blondo, MSW, LCSW-C, LICSW, CMAC, ACM, CCM, C-ASWCM, ACSW.

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