Emergency department case management program

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Included but not limited to this, is obtaining medical records, facilitating tests, treatments and medication procedures, Acute Care bed management, communication with patient and family to reduce anxiety and offering alternatives to admission.

Once the decision is made that a patient meets the acute care criteria, a standardized Case Management Assessment would be completed. This serves as a one-stop location for information from the Emergency Department, family and any other sources. In addition, initiation of an insurance review and discharge plan will aid the In-patient Case Manager. This step also includes an awareness of High Utilization Patients; those patients who visit the E. Monitoring the documentation started in the Emergency Department for accuracy and completion for coding and reimbursement purposes.

For example, when an actual diagnosis is unclear, the ED Case Manager works with clinical staff to ensure any ruled-out diagnoses are documented. Delays in status determination often occur when critical documentation, including diagnostic test results, are unavailable at ED admittance. To avoid these delays the ED case manager should speak to an ED provider to understand their clinical impression of the case.

This will provide them with the information needed to discuss the expected treatment period, and appropriate admission status and level of care with the admitting provider in order to complete the initial medical necessity review. There are many effective models for discharge planning. Best practices include:. Following these best practices ensures that all employees are practicing at the top of their license. Transition planning from a team of ED case managers and ED social workers can involve assistance with setting up equipment and medication, home health referral and post-acute facility transfers.

The team should collaborate with the ED provider to understand the expected needs of the patient and provide recommendations for safe transition plans to prevent inappropriate inpatient admissions.

While many physicians do not feel confident in addressing the social needs of patients and may not have the capacity to do so in the fast-paced ED environment, collaboration with this team can fill that gap and provide patients with a strong network of resources to reduce risks of repeat ED visits. Approximately percent of readmissions are caused by lack of resources and social problems.

As a result, it is critical to discharge patients from the ED with appropriate resources and services that mitigate the risk of readmission. Under value-based payment models, providing the appropriate type of care in the appropriate setting becomes increasingly important. Many patients who are high users of ED services do not need this high level of care and as a result hospitals must try to redirect these patients to other care settings.

ED case management programs can put a plan in place that will do just that. The first step that must be taken is to establish criteria that defines a high user. Then, when a patient who meets high user criteria is admitted, they would automatically be flagged in the EHR.

Cesta, Ph. The author of nine books, and a frequently sought after speaker, lecturer and consultant, Dr. Cesta is considered one of the primary thought leaders in the field of case management. Prior to her current work as a case management consultant, Dr.

She was responsible for case management, social work, discharge planning, utilization management, denial management, bed management, the patient navigator program, the clinical documentation improvement program and systems process improvement.

Cesta has presented topics on case management at national and international conferences and workshops. What you'll learn? Overview of the webinar Case management models in the acute care setting are constantly evolving and improving.

Who should attend? Why should you attend? Faculty - Dr. Cesta Toni G. Add to Cart. Recorded Options.