Our Story
by Elaine Hobein

Our story is similar yet different from many others. Four years ago, the administration of our 167 bed acute care hospital made the decision to radically change the structure of our Case Management Department. Before this change, case management, utilization review, and social work were a single department under the vice president of finance. With an ever tightening budget, administration saw the need to allow case managers more time to work with patients, physicians and hospital staff to facilitate quality care and to decrease the length of stay.

The department was reassigned to three separate areas. The RN case managers, who performed both case management and utilization review, were given the option to become either unit-based case managers or utilization-review nurses. The case managers would function under the assigned nursing unit director. Utilization review would be managed by a supervisor under the vice president of finance. Social work and pastoral care would become one department and operate through the vice president of organizational development/human resources. Our challenge as a group was to find ways to communicate effectively to achieve the continuity of patient services that we had smoothly and efficiently provided while working together as one department.

Today, after many revisions to the case management structure, our communication strategy is more interdisciplinary. In addition to formal multidisciplinary rounds, which occur twice weekly, case management, social work, utilization review, and the lead RNs meet together daily to discuss patient needs. The case managers are also involved in the twice daily bed placement/staffing meetings with the house administrator. Furthermore, weekly meetings continue to take place with the physician.

Meetings for case management to discuss patients who are outliers for cost of care and/or length of stay, however, have grown to include members of decision support and the vice president of acute care services. It is through these communication efforts that we have been able to enhance our ability to work together to provide for the individual needs of our patients, as well as to gain better insight into the needs of our organization.

Controlling length-of-stay has continued to be a challenge. In 2005, administration began meeting with the case managers with the goal of finding a way to further decrease length-of-stay. Again effective communication became the key. Through these meetings, stickers were designed for the front of patient charts alerting the physicians and staff to the anticipated discharge dates based on the projected DRG geometric length of stay. Within three months of implementing this program, we saw our average length-of-stay drop below four days. It has remained stable for the past six months.

New challenges will always be before us as case managers in the changing world of healthcare. By making a concentrated effort to work together as a team and by communicating effectively with all members of our hospital staff, we have shown that we can overcome challenges that at times have seemed hopeless.