Another View of Case Management: Case Management within the VA
by Gloria M. Serrano-Fout, RN-BC, BSN

The Carl T. Hayden Veterans Affairs Medical Center (CTHVAMC) is proud to serve veterans. This population is a unique clientele that requires creative and critical thinking skills to identify and meet their needs.

The CTHVAMC is a teaching facility that hosts a residency program. The interns and residents rotate monthly between various local hospitals. It can be challenging for them to learn the “system” for each facility. Within our facility, nurse case managers continually educate and re-educate them regarding when and what services need to be ordered in preparation for discharge and outpatient follow-up.

The nurse case managers at the CTHVAMC play a significant role within the interdisciplinary team to coordinate health care services. With other disciplines, a daily interdisciplinary team meeting was developed to facilitate the discharge process. This venue includes departments that play a crucial role in the care of veterans. Nurse case managers, staff from pharmacy, rehab medicine, wound care, home care, social work and the medical residents participate in this daily meeting. The surgical residents meet with nurse case managers prior to their surgical cases every morning. The goals of the meetings are to share and identify information regarding the veterans’ health and discharge needs, how to decrease fragmentation and duplication of care, decrease length of stay and enhance quality of care.

The CTHVAMC nurse case managers conduct an initial assessment/interview with each new patient. The case manager identifies functional status, support system, living arrangements and equipment needs. Identifying discharge needs early in the admission process aids in discharge planning and facilitates a safe transition home.

In addition to weekday inpatient case management coverage, a proposal was made to extend case management coverage to include weekends. This proposal was made to maintain continuity of care, avoid delay of services, decrease length of stay (LOS) and increase patient satisfaction.

On weekends there are limited discharge services available ? e.g., home oxygen, home care, hospice, rehab medicine, social services and transfer coordination to other facilities. The weekend nurse case managers have intervened to obtain these services with outcomes of a decrease in bed days of care (BDOC) due to unavailable services. The interns and residents have point of contact to discuss discharge challenges that arise on weekends.

The nurse case management weekend coverage has contributed to a decrease in BDOC and significant cost savings. In 2006, weekend case management was instrumental in decreasing BDOC by 44, with a cost savings of nearly forty thousand dollars.

Nurse case management offers a unique insight to patient care needs, and having guidance from a core group has proven to be essential for efficient patient care. The added presence of weekend nurse case managers has provided assistance to staff nurses when they are unfamiliar with complex hospital and community resources. Patients, families, physicians and nursing staff have voiced their appreciation and satisfaction with nurse case managers being available on weekends to assist with challenging discharges and coordination of unplanned discharge services.