Q&A: Structuring care coordination rounds
Q: Do you have any advice on how to structure rounds for a hospital case management team?
A: Care coordination rounds have become the centerpiece of medical-surgical case management. Their rationale is to confirm the diagnosis or rule-out status, know the patient and family story, increase safety, ascertain risk, pace the care, plan for the next level of care, learn from each other, and monitor the LOS. They should occur at least three times a week, if not daily. The minimum amount of people necessary to make them effective are (1) staff nurses presenting one at a time or charge nurse, (2) case manager(s), (3) social worker. On a 25-bed unit, they should take no longer than 30 minutes each day.
How to start a program and structure care coordination rounds:
1. To make sure care coordination rounds become a high priority in the organization, the VP of Patient Care or Nursing must establish that they are crucial for patient care, safety, and professional growth. The director of case management and the case management personnel who interact with each unit should meet with nurse managers and charge nurses of units to establish time frames and responsibilities. Review what will be considered successful and agree to an evaluation. Get cooperation from all disciplines about how much attendance and what kind of information will be needed.
2. Care coordination rounds are a safety net that can be a platform for escalating patient care situations to other forums such as complex care rounds, ethics, and legal intervention. All patients should be reviewed during care coordination rounds, which can prevent more serious problems.
3. Attendees should include a leader/facilitator, direct caregivers, and specialty staff such as pharmacy or nutrition. Do not expect MDs to attend, unless they are unit-based hospitalists or intensivists. The leader may be the nurse manager, the case manager, or the social worker.
4. When presenting each patient, the following information should be given and discussed:
- Name, age, MD, LOS to date
- Admitted from and on what date
- Who is family spokesperson?
- Anticipated discharge plans A and B
- What do we need to do today to move the patient to tomorrow (note: not necessarily to discharge)?
- Next steps and who will do them?
- Which doctor is on call for this patient today?
5. Structure for care coordination rounds:
- Same time, same place every day
- Start on time, end on time
- Not out in open, ensure privacy
- Expect attendance or replacement
- Introduce new people, such as students
- Be a timekeeper or appoint one
For more information, see Case Management Models: Best Practices for Health Systems and ACOs, Second Edition. 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.