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Case Management in the ED: Why It’s More Important Than Ever

by Mary Kay Thalken, RN, MBA on Jun 21, 2019

ED Case ManagerCommon wisdom suggests, when a person comes to the Emergency Room, they do so because they need emergency care. It’s up to nurses, physicians and available specialists and staff to provide the appropriate treatment as quickly as possible, with follow-up care tended to after the fact.

But while this need to provide expedient care is certainly necessary when it comes to trauma and other serious medical emergencies, a large number of people who visit the ED may not need emergency care, and if a case manager can intervene to connect the patient with the more appropriate level of service and match their ensuing follow-up care to the actual level of acuity, patients and hospitals both benefit.

And that’s only the beginning. It turns out, a case manager can help the Emergency Department in three very specific ways.

Appropriate Intake

The ED case manager’s role begins the moment a patient walks through the doors, as they evaluate the individual’s needs and make determinations as to the type of care that would be most appropriate.

Because of this, we recommend having a case manager who has a clinical background. When deployed to an ED setting, it’s crucial for the individual to make quick decisions regarding the person’s needs and refer them appropriately.

The case manager should be heavily involved with the intake of the patient, looking closely at their medical history to determine if this is a one-off incident or part of a pattern (which will come in handy later when creating a successful post-acute care plan). The case manager can also make themselves available to the patient to ask pertinent questions regarding their medical and social history and the issues leading up to this particular episode.

You can see why a clinical background is crucial during this step of the process. By asking questions and examining the patient’s medical history, the case manager can evaluate whether or not emergency or acute care is more appropriate. They can refer the patient to the appropriate level and type of care and/or services, saving the patient cost and the hospital resources, potentially speeding up the provision of care by avoiding the missteps by automatically assuming emergency services are the best course of action.

Case Manager with KidSeeing the Forest Through the Trees

One incredibly valuable job function of an ED case manager is their ability to evaluate the totality of a patient’s circumstances and the hospitals’ resources as a whole.

Whereas a physician or a nurse are focused on getting that individual the care they need right away, the case manager can take the long view. With the right guidelines in place for how and where to refer patients, the case manager can look at the totality of that person’s circumstances and transfer them within the facility accordingly. The physician will always have the ultimate say, but the case manager might be able to recommend more tests or a non-emergency intervention. They can even spot weaknesses in hospital workflow that prohibit high-quality patient handoffs and correct those issues accordingly.

More than just lending support to clinical decisions and workflows, a case manager who has access to additional information about the hospital can also quickly move their patients through the system. It’s not up to a physician or the patient’s care team, in the moment, to know what acute bed they’ll be referring their patients to, which is why this step of the process can take hours once emergency care is finished. But with a case manager readily available, he or she can immediately be consulted to determine where the patient will be transferred. By understanding current staffing levels, the case manager can identify who their post-emergency care team will be and even transfer them to units and beds where they’ll receive quicker, more appropriate treatment.

Having a case manager tracking this information is crucial, as the clinical team can quickly consult them and then move on to the next patient. Hospital resources experience minimized strain, and the patience experience is improved because they’re graduating to progressive levels of care more quickly than is typical within an ED.

Case Manager Explaining OptionsPost-Acute Considerations

The one place where an investment in an ED case manager really proves its worth is in the knowledge and understanding of the post-acute space.

Because the case manager is working with the patient from the moment of intake, he or she is uniquely positioned to identify the post-acute care needs of the patient once they leave the ED and the acute care setting.

These needs can take two forms, each of which benefit from having a case manager available for evaluation: clinical needs and social needs.

Clinical needs are determined based on clinical diagnosis and the care plan that follows the individual’s treatment. Your hospital or health system no doubt has documentation in place to govern what the patient’s goals are following discharge. The case manager can begin to put together the patient-facing version of this care plan immediately after intake and/or diagnosis.

A case manager in the ED can also get the ball rolling on the discharge process itself. If the patient has sustained a cardiac episode, for instance, and you know they’ll need follow-up care at a post-acute care provider in a couple days, the case manager can narrow down the most likely options for bed availability and have those options ready for the patient and their family to review when the time comes. With the right technology, you can proactively identify whether these facilities will have beds available.

But it’s not just clinical matters the case manager will assist with. By reviewing the patient’s social determinants of health, the case manager can deduce whether or not it will be appropriate to refer the individual to services that exist outside the clinical space.

For instance, if the patient arrived via public transportation and doesn’t have family in the area, the case manager can assign the necessary Non-Emergency Medical Transportation. If the patient’s diagnosis suggests an alteration to their diet, the case manager can suggest that the discharge team set that person up with food deliveries. The case manager can even determine the best methods of follow-up and assign social workers based on the patient’s access to email, phone and more.

Case Management Is Changing How Hospitals Approach Care

Hospitals are beginning to see the value case management has, not just during the discharge process, but in all departments, including the ED.

By evaluating the patient’s needs in comparison with hospital resources from the moment of intake all the way through to discharge and post-acute care treatment and follow-up, a case manager can improve the patient experience, decrease utilization of unnecessary hospital resources and enhance workflow across the spectrum of care.

Case management in the ED may not be common in every organization, but it’s definitely time to consider the benefits it might bring to an overburdened system. It’s about getting patients the right care when and where they need it. With the technology in place, hospitals and health systems can do just that while saving valuable time and resources for those who need it most.

How much can your organization save with automated discharge technology? Calculate your ROI.

Meet the Author

Thalken brings more than 30 years of experience in health-care leadership to our company. Prior to joining the company, she served as Enterprise Vice President for Care Logistics in Atlanta, Ga. She has held executive leadership positions at hospitals in Nebraska and Iowa, including the position of System Quality Executive for Alegent Health. Thalken has presented on the topics of improving quality, patient flow and throughput at various industry conferences and webinars. Thalken holds an MBA from the University of Nebraska at Omaha. She is a member of the American College of Healthcare Executives, American Organization of Nurse Executives and American Case Management Association.

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