Care Management Services ensures
smooth patient flow and continuum planning

By Bonnie Geld

The Care Management Department of Texas Children’s Hospital was developed to provide oversight and management of the patient continuum of care processes, most specifically in utilization and care coordination. The goals of the department are to decrease length of stay (via proactive discharge planning processes), manage the cost of care, ensure appropriate reimbursement, and maintain the integrity of documentation as it relates to patient visit type.

	The Care Management Department has a leadership role in the organization’s goal to improve patient flow and continuum planning.

Nurses in the Care Management Department are split into two categories: resource utilization nurses and care coordinators. Along with the social workers in the Social Work Department, these individuals comprise the Triad Case Management teams. As a team, they are charged with collaboration and integration of services to meet the goals of the care management umbrella (Care Management and Social Work). The care coordinator takes the lead in coordinating the continuum plan of care with the team. Team membership may include financial counselors, child-life specialists, respiratory therapy, physical therapy, unit-based nursing, and physicians. The resource nurse takes the lead in early identification of complex cases and concurrent, timely review of the medical record. It is the expertise of these nurses that will ultimately create a seamless care management product that is useful to the units and physicians, and promotes the strategic goals of the organization.

The department is comprised of a director, assistant director, educational/PI specialist, 10 care coordinators and nine resource utilization nurses. In addition, the department has one CPS nurse case manager, and an administrative assistant and department secretary. We are asking for the addition of one resource utilization nurse to oversee appropriate admissions in the Emergency Center.

The department also has the support and assistance of two physician medical directors. Dr. Yong Han assists in overseeing and supporting the care management processes, and Dr. Steven Whitney chairs our Utilization Review Committee. A physician advisory committee also has been formed to support the care management process and provide timely feedback of appropriate and helpful process changes.

The Care Management Department has a leadership role in the organization’s goal to improve patient flow and continuum planning. Several reports will be generated by Care Management to identify process success as well as organizational opportunities for improvement in care planning. They will include productivity reports, disposition reports and avoidable day reports (MOD).

The department is also implementing Interqual Care Enhance Manager, a technological solution to improve the integrity of reviews and efficiency in the process for resource nurses.

In this coming year, the department plans to facilitate a process change for care management by implementing triad case management on all inpatient units.

Bonnie Geld is director of Care Management and Social Work.

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