Jennifer Ryland, Chief Administrative Officer of Jackson Medical Center (JMC) in Jackson, AL wanted to further their success by improving their case management processes. Case management allows for an interdisciplinary team approach while requiring physician alignment and promoting the patient and family experience. The Case Management Society of America defines case management as "a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individual's health needs through communication and available resources to promote quality cost-effective outcomes."
Case management is a key position in a hospital with multiple tasks to manage and it has a direct impact on quality of care, compliance and revenue. Case management should also be a part of a hospital's performance and quality improvement processes. A true case management process starts with chart review and the determination of potential needs based on provider and nursing documentation. This is followed by a meeting with the patient and family as needed to ensure that all aspects of the discharge planning have been addressed. Then the case manager meets with the physician to discuss their plan and findings that may assist or interfere with the plans. With all of these responsibilities, a hospital needs an efficient, well-organized case manager.
Ryland shared the following information about their case management project with RHPI.
Q: Why did you choose to focus on case management for your RHPI project?
A: A Case Management project was chosen because we felt our Case Management program was lacking the processes needed to have a strong effective program. The Case Manager had become very overwhelmed with the increasing demands for consistent effective discharge planning to reduce readmissions and the increasing/changing admission criteria resulting in a higher percentage of patients placed in Observation services.
Q: What is your hospital's current status with regards to implementing the recommendations made during this project?
A: We have currently implemented approximately ninety percent of the recommendations made during this process and are continuing progress during the coming year. The Care Manager resigned her position shortly after our project began. The new Care Manager was able to enter into the role with the tremendous advantage of having Mary Guyot's (Stroudwater Associates Consultant for this project) findings and recommendations, as well as, set action plans. Some of the greatest successes have been: revising our Discharge Planning Process to include discharge planning initiated within 24 hours of admission; revising our Discharge Follow-up process; and, training Shift supervisors on Interqual criteria giving us the ability to get the patient in the right bed status on admission around the clock.
Q: What were the anticipated outcomes of this project? Has your hospital been able to document any of these outcomes?
A: Some of the anticipated outcomes were:
- Improved processes for the Case Management department to improve documentation and ensure CMS compliance
- Initiate a discharge follow-up process for 85% of discharges meeting criteria for follow-up
We have been able to document accomplishments for the outcomes above, as well as others. The new processes, including the discharge follow-ups are working great. We are already seeing a reduction in our readmission rate, better communication between providers and a decrease in the number of admission status changes.
Q: What are the expected next steps towards adopting your consultants' recommendations? Is there a sustainability plan?
A: We will continue to implement many of the recommendations this coming year. Continuing to work on readmissions and revising Case Management processes.
Q: Is there anything your hospital would do differently if you were able to repeat this experience?
A: No, this was a great experience for us. Mary did an outstanding job and really gave us a clear picture of where we were and where we needed to be.