Photo by Gabriel Crismariu | Unsplash
Even before the coronavirus crisis, managing hospital flow had been difficult for many hospitals. Now, as health systems gradually return to providing elective surgeries and other delayed and deferred care — even as they continue to care for COVID-19 patients — the risk of volume surges will pose challenges and make managing flow even more complicated. Optimizing case management will become more important.
Case managers are the primary point of contact on a health care team and assist patients and their families with coordinating services and resources to address their immediate and transitional needs. Case managers, working closely with social workers and other providers, help ensure that patients are engaged and actively participating in the plan for discharge from the hospital.
As the COVID-19 pandemic evolves, there may be a small window of opportunity starting this summer to develop an effective case management process that supports improved capacity. If, as some predict, there is another surge of COVID-19 patients (in addition to seasonal flu patients), this window may close quickly in the fall and the system may again be overwhelmed. Effective case management can help ensure patients are steered to the proper level and sites of care as either inpatients or outpatients.
As capacity continues to be at a premium, case managers will have to monitor the appropriateness of patient admissions and length of stay. They will also need to help patients who need support related to the social determinants of health, ensure timely insurance authorizations and bed availability, and work with post-acute care facilities on discharge planning.
Case managers contribute to improving patient flow by managing how patients enter and leave the hospital. With the aid of evidence-based tools and criteria, they determine appropriate status in partnership with physicians during the admission decision-making period. A patient can be identified as an inpatient, an observation patient, or as an outpatient (in a bed). They have five points of access to care inside the hospital: the emergency department, scheduled admissions, transfers, direct admissions, and internal transfers.
To develop an appropriate and timely transition plan, case managers and social workers must use their clinical skills to comprehensively assess each patient. Understanding the patient’s clinical, financial, and psychosocial needs (working with patients and their families) helps the team develop an effective plan.
Effective discharge planning requires the following steps:
- Develop a comprehensive care plan for transitions and follow up through well-coordinated assessments, partnerships, and patient engagement.
- Identify and connect patients to services that will provide for psychosocial needs and address social determinants of health through community advocacy.
- Connect patients with complex needs to ambulatory case managers, primary care physicians, and specialists.
- Collaborate with post-acute care facilities for timely transfers.
- Engage patients and families in recovery and next steps through patient communication and patient education.
Effective case management has historically been an important tool for helping to manage flow. It will be even more critical as organizations face not only the typical challenges of managing patient volume and capacity, but also the added stressors of the short- and long-term effects of the coronavirus.
Bonnie Geld is President, The Center for Case Management and faculty for IHI’s Hospital Flow Professional Development Program.
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