Emergency Department Case Management: The Compendium of Best Practices

About this book

Emergency Department Case Management: The Compendium of Best Practices Second Edition Kathleen Walsh RN PhD Karen Zander RN MS CMAC FAAN Contributors: Christina Boyd BA MPH Sean Burton CCEMT-P Sarah B. Carignan BA MBA Mary G. Daymont RN BSN MSN CCM Bonnie M. Geld MSW Patricia B. Green LMSW Deborah Hale CCS CCDS Ann Marie Hill MSW LiCSW Eileen Hughes RN MBA Joan Stack Kovach RN MS PC J. Michelle Moccia MSN RN ANP-BC CCRN Chris Nesheim RN MS CMAC Suzanne OConnor RN MS CS Maria Seavey RN BSN Sallie A. Selfridge LBSW Andrea Snyder RN CCRN Rowena (Ricki) Stajer RN MA CPHQ Dawn Williamson RN MSN PMHCNS-BC CARN-AP From defining goals clarifying roles and understanding the necessary knowledge and skills required Emergency Department Case Management: The Compendium of Best Practices 2nd Edition will ensure that ED case management staff have a solid and sustainable foundation in place. After exploring models and reviewing emergency department infrastructure this compendium will help readers outline key partnerships present multiple options for case finding tackle observation status accurately address quality and evaluation issues and identify ways ED RN case managers and social workers coordinate care for complex cases such as pediatric psychiatric homeless and uninsured populations. In addition to many new tools this book is also packed with more than 20 detailed spotlights and case studies discussing ED case management strategies best practices and experiences of ED professionals from across the country. The new edition includes: The presence of case management RNs and Social Workers in emergency departments (ED) has become a standard since the first edition of this text was published in 2007. Ever-expanding and changing regulations for EDs and hospitals have emerged while best practices have evolved to address these challenges. This new edition discusses these changes and provides updated guidance on running a compliant effective and efficient case management team in the ED. It also provides insight on adapting the role of case management based on unique ED patient populations and helps ED case managers stay ahead of the curve by examining what lies ahead in their profession. Table of contents Chapter 1: ED Case Management: The Heart of Access and Hub of the Community Learning Objectives Introduction The Evolving Role of Hospital EDs Functions and Models of CM Emergency Department Role Definitions Based on Hospitals Organizational Structure Precursors to CM in the ED RN CM role as Enhanced Expertise for the ED Dovetailing with the Hospitals CM Service The Future of ED CM Spotlight 1-1: A Piece in the PuzzleDevelopment of a Health System-Wide Transfer Center Spotlight 1-2: Spotlight 1-2: Connecting CM and Patient PlacementStrengthening Resources to Manage Hospital Entry References Chapter 2: Strategies for Creating a Successful ED CM Program Learning Objectives Introduction Creating and Sustaining a Successful ED CM Program ED CM Responsibilities Importance of Partnerships Importance of Orientation and Preceptor Program: ED CM Orientation Spotlight 2-1: ED CM: More Important Than Ever! Spotlight 2-2: First Impressions Last: Quickly Build Trust and Cooperation to Achieve Better Outcomes References Chapter 3: Quality and EDs Learning Objectives Measuring Quality in Healthcare Hospital Value-Based Purchasing New Quality Measurement Efforts The Case Management Bridge to the Community References Chapter 4: CM for Short Stay/Observation Patients Learning Objectives The CMs Role in Facilitating Appropriate Level of Care Level of Care Order Determines Payment to the Hospital Inpatient Admission Orders Outpatient Observation Services Outpatient with Extended Recovery Admission Necessity Is an Important Component of Organizational Compliance Medicare Inpatient Admission Criteria Admission Criteria Change Expected Outcome of Admission Criteria Change Strategies for Success Spotlight 4-1: Observation Unit SpotlightOne Administrators Experience Opening an Observation Unit in an Urban Academic Medical Center Spotlight 4-2: A Day in the Life of an Acute Hospital Observation Case Manager Chapter 5: Case-Managing Challenging ED Patients in General EDs Learning Objectives Frequent/High Utilizers in EDs for Non-Acute Care Palliative Care in the ED Medicaid Healthcare Reform and ED Visits Undocumented (Illegal) Immigrants Spotlight 5-1: Decreasing ED Use by Multi-Visit Patients Spotlight 5-2: UnityPoint St. Lukes Hospital ED Consistent Care Program Spotlight 5-3: Using Technology to Enhance Care Coordination for High Utilizers and Complex Patients in the ED Spotlight 5-4: Boarding of Behavioral Health Patients in the ED: A Snapshot of Metropolitan Chicago Hospitals References Chapter 6: Special EDs for Special Populations Learning Objectives Introduction EDs for the Psychiatric Population(s) Responding to the Population with Mental Health Needs E