All Entries Tagged With: "communication"

Case Management Week is almost upon us

Case managers, next week is all about you. October 11-17, is National Case Management Week, which is your opportunity to spread awareness about what case managers do and how they improve healthcare across the continuum of care.

Several case management associations have released information that describes how you and your staff members can celebrate all things case management.

If you are looking for National Case Management Week posters, banners, and pins check out the American Case Management Association’s National Case Management Week catalog.

The Case Management Society of America (CMSA) put out a 20-page packet that is full of ways you can raise case management awareness:

• Individual activities
  • Tell 10 other professionals you are a case manager.
  • Offer to speak at community events on case management.
  • Write letters to your local paper. Contact radio and TV stations to let them know about CM Week.
  • Write a guest editorial to newspapers, journals or magazines regarding the positive impact of case management.
  • Distribute a press release announcing National CM Week.
• Community activities
  • Host a celebration or reception to recognize a case manager in your community.
  • Host professional seminars and workshops for health professionals in your community.
  • Arrange exhibits and displays in public facilities.

This is not an exhaustive list. See the full list of suggestions at the CMSA Web site

Please share your plans for National Case Management Week.

CMW news: Incomplete discharge summaries to blame for preventable errors

A study released by the Indiana University School of Medicine finds that hospital discharge summaries lack information important to patients’ continuity of care.

Indiana University School of Medicine researchers published their findings in the September issue of Journal of General Internal Medicine under the title Adequacy of Hospital Discharge Summaries in Documenting Tests with Pending Results and Outpatient Follow-up Providers.

The researchers reviewed 668 discharge summaries from two academic medical centers. They found that the hospitals discharged nearly 41% of the patients with test results pending—9% of those tests required changes with respect to patient care. However, the hospitals documented only 16% of those tests in patient discharge summaries. Only 13% of summaries included all pending tests.

Researchers say without that information, primary care physicians can’t provide the appropriate care patients need after discharge.

"Errors in communication reportedly contribute to over half of all preventable adverse events and are associated with twice as many deaths when compared with errors due to clinical inadequacy,” researchers conclude in their report.

Source: American Academy of Professional Coders and American Medical Association

Whiteboards help communicate across departments

Placing whiteboards at the foot of the patient’s bed was innovated by Planetree, a not-for-profit organization that works with hospitals to improve the patient experience and it has spread across the country.  Unfortunately, in most hospitals whiteboards stand blank except for some flower doodling. That’s a shame because whiteboards are a fantastic way for departments to talk to one another and the patient about the plan of care in a simple, direct, way.

The intent of whiteboards is much more than simply identifying discharge dates and times. The whiteboard is meant as a means of communicating the plan for the patient’s day—what tests, what new procedures, and medications the patient can expect on a given day. Just think, different caregivers can walk into a patient’s room and in a glance see what the attending physician has prescribed for the day. For the patient’s benefit, information written on the whiteboard should be in layman’s language. Patients don’t know what NPO stands for.

Using the whiteboard as a means to inform everyone of the patient’s targeted discharge is example of making sure everyone is on the same page regarding progression of care plans for the patient. According to nurses and case managers I have spoken with, the feedback from patient families is consistently positive.

However physicians are not always excited about whiteboards. In one client hospital, physicians were annoyed and complained to the CEO when staff members started using whiteboards to write patients’ plan for the day and targeted discharge. He was seriously thinking of putting a stop to their use, but the physicians’ complaints were quickly over-taken by the number of complements he received from patients, families, and hospital caregivers. Even dietary and housekeeping staff members endorsed the practice.  So, the CEO told the grumbling physicians to learn to deal with it….they are staying.

Does you facility use whiteboards? If so please share the ways you use them to communicate and how you handle HIPAA concerns.

Documentation requirements for critcal care services

Editor’s Note: This blog was originally posted by Melissa Varnavas, CPC, the associate director of the Association for Clinical Documentation Improvement Specialists, for the ACDIS Blog. Read the original post here.

In the July 23 issue of CDI Strategies, Robert S. Gold, MD, founder of DCBA, Inc., in Atlanta, offered a tip to help CDI specialists gain physician support for improved documentation in the medical record regarding critical care. In a subsequent e-mail, Gold added comments from his “guru” on physician professional billing, Paul Dickson, MD.

Here is the amended information:

Critical care does not include ongoing monitoring of a patient who has stabilized, regardless of how many organs have failed in the past, but have now stabilized, how many lines and tubes were inserted, or how many devices were instituted. When the patient is stable, it is not critical care.

Too many physicians, however, do not realize that we can bill:

• Critical care delivery by time increments for the first encounter
• Additional critical care when the patient crashes again
• A level three subsequent visit for noncritical care in addition to the critical care delivery on the same day

Any usual evaluation and management (E/M) service appropriate for services and documentation provided may be billed prior to a critical episode, but not vice versa. Consider the following case study.

A patient presents to the cardiac care unit after a coronary artery bypass graft. The patient is intubated with a left ventricular assist device still in place but is not active and receives low-dose dopamine for renal perfusion. The patient’s vital signs are stable with a little hypotension due to lack of vascular tone due to residual effects of anesthesia, however, it is easily controlled. The external pacer is in place, chest tubes are in place to underwater seal, and diluted urine is flowing through the Foley. A physician accepts the patient onto the intensive care unit (ICU) and performs an evaluation. The patient is not critically ill. However, the patient is on a respirator, and the physician manages that respirator. This may be ventilator management 94002-3 alone, and no E /M service may be billed with these codes.

In this case, the patient does not have acute respiratory failure. Writing the words “acute respiratory failure,” means a condition exists that involves the respiratory tree due to a disease process. If, indeed, the patient does have acute respiratory failure due to a disease process when he underwent the surgery, then it is appropriate to document that, if it still exists. If this is not the case, then the presence of the words “acute respiratory failure” will give the heart surgeon a black mark since the condition would be considered a complication of the surgery. [more]

Can Twitter improve healthcare communication?

Twitter, the social network based around the phrase “What are you doing right now?”, continues to gain popularity in world of healthcare.  But can it help improve communication with patients’ families?

Children’s Medical Center in Dallas thinks so.

The latest facility to “tweet” during surgery (a concept created in February by Henry Ford Health System), Children’s sees the technology as a way to help communication between physicians and families.

Read more about the idea here.

Do you use Twitter? Know anyone that does? Feel free to share your thoughts.

Denial Management – how strong is your process for concurrent denials?

We are evaluating our denial program only to assess that it was not as strong as we would like. As case management departments prepare for upcoming Recovery Audit Contractor (RAC), retro denials from health plans, and concurrent denials.
Our case management department looked at our process and it became clear that our management of our inpatients denials lacked process delineation. We began to re-assess this specific process as well as redefine our entire denial program.
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Time-saving strategies for hospital case managers!

The job of a hospital case manager is complex, to say the least. Between keeping up with regulatory changes, ensuring proper clinical documentation, planning for appropriate discharge, and making sure patients receive adequate care while your facility maintains fiscal integrity, it can be difficult to juggle all that needs to be done.

In an upcoming issue of Case Management Monthly, we’d like to feature the top ten time-saving tips for hospital case managers from you, our readers. Help your fellow hospital case management professionals beat the stress of their job and optimize their time by sharing your best time-saving strategies. Send your tips to Managing Editor Janelle Randazza; all selected entrants will be featured in the June 2009 issue of Case Management Monthly and will receive a free copy of the issue.

Challenges for case managers in discharge planning

Discharge planning is a constant state of mind for our case management team. We continually strive to create a plan that is safe and comprehensive.
Discharge planning is also a major focus of accrediting agencies including both The Joint Commission (formerly JCAHO) and the Centers for Medicare & Medicaid Services (CMS). Our case management team has found that creating a safe discharge plan and initiating a thorough multidisciplinary assessment (including functional, psychological, and cognitive) within the first twenty-four hours has been a challenge. The challenge in safe discharge planning is usually the coordination of critical communication of all team members.
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Has human communication been forgotten in the hospital?

As a hospital-based case manager, have you ever wondered if the right hand knows what the left hand is doing?

Every healthcare provider touts they are doing what is right for the patient, providing what the patient needs, with the goal being that of getting the patient ready for discharge. In reality, everyone is working independently of each other and in some instances you may find there is one interdisciplinary group working against another. As the director of case management, knowing the case management role is to provide collaborative care to patients in a timely and cost effective manner, I also know that it is essential for the entire healthcare team, including the patient, to have a common goal. It is also important to discuss the goal and the steps necessary to achieve the goal. One thing I have found is, no matter how big or small a hospital is, communication among interdisciplinary groups is almost non-existent; I think our great advancements of computer charting has made human communication unnecessary. [more]

Clinical Social Worker (CSW) or Registered Nurse (RN)?

Effective working relationships between nurses and social workers are the foundation of effective patient care management. Both disciplines bring value and there own unique perspective to the patient/family situation. But philosophical differences, and unclear role delineations can sometimes disrupt collaboration among the two.

HCPro has offered two audio conferences devoted to this subject. Where do you sit on the case management spectrum? Are you an RN or a LCSW?