Emergency Department Case Management: The Compendium of Best Practices, 2nd Edition

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Emergency Department Case Management: The Compendium of Best Practices, 2nd Edition

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Emergency Department Case Management: The Compendium of Best Practices,
2nd Edition

Kathleen Walsh, RN, PhD
Karen Zander, RN, MS, CMAC, FAAN

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.

Continuing Education

This book has been pre-approved by the Commission for Case Manager Certification to provide continuing education credit to CCM board certified case managers. The course is approved for 14 CE contact hours.

Who should read this book?

  • Case managers
  • Directors of case management
  • ED nurse managers
  • Social workers
  • ED directors and administrators
  • CFOs

About the Authors

Kathleen Walsh, RN, PhD, is a consulting associate with The Center for Case Management. Dr. Walsh has over 30 years of strong nursing experience in the clinical, administrative, and educational arenas. Her vast knowledge of emergency care highlights her expertise in emergency department (ED) case management (CM). Over 17 years ago, Dr. Walsh was among the first to pioneer the ED CM role at Massachusetts General Hospital, a Harvard affiliated level one trauma center in Boston. Prior positions include clinical emergency nurse, clinical nurse specialist, and director of education. She holds a master’s degree from Boston College and a PhD in nursing research with a focus on nurse presence from the University of Connecticut. Dr. Walsh has mentored numerous clinicians across the country in building, establishing, and/or strengthening ED case management programs.

Karen Zander, RN, MS, CMAC, FAAN, is president and owner of The Center for Case Management in Wellesley, Massachusetts. Her pioneering work with clinical case management and CareMap® systems, begun at New England Medical Center Hospitals in Boston, is internationally recognized. Hospitals and Health Networks has named her a "Cutting Edge" leader. She is the editor of Managing Outcomes Through Collaborative Care, from the American Hospital Publishing Co, and The New Definition newsletter.

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 O’Connor, 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

Published: November 2014

Table of Contents

Chapter 1: ED Case Management: The Heart of Access and Hub of the Community
Learning Objectives
The Evolving Role of Hospital EDs
Functions and Models of CM
Emergency Department Role Definitions Based on Hospital’s Organizational Structure
Precursors to CM in the ED
RN CM role as Enhanced Expertise for the ED
Dovetailing with the Hospital’s CM Service
The Future of ED CM
Spotlight 1-1: A Piece in the Puzzle—Development of a Health System-Wide Transfer Center
Spotlight 1-2: Spotlight 1-2: Connecting CM and Patient Placement—Strengthening Resources to Manage Hospital Entry

Chapter 2: Strategies for Creating a Successful ED CM Program
Learning Objectives
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

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

Chapter 4: CM for Short Stay/Observation Patients
Learning Objectives
The CM’s 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 Spotlight—One Administrator’s 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. Luke’s 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

Chapter 6: Special EDs for Special Populations
Learning Objectives
EDs for the Psychiatric Population(s)
Responding to the Population with Mental Health Needs
EDs for Pediatric Populations
CM in a Pediatric ED
EDs for Senior Populations
The Gray Tsunami: Is Your ED Senior-Ready?
Spotlight 6-1: How Might a Mobile Healthcare Provider Expand the Reach of an ED in Your Community?
Spotlight 6-2: Retail Clinics

Appendix A: EMTALA: The Emergency Medical Treatment and Labor Act
Appendix B: ED Case Manager Competencies and Guidelines for Use
Appendix C: What Every Inpatient and Family Should Receive From CM and Social Work Services
Appendix D: CM and MSW Caseloads by CMI and Payer Framework to Plan, Evaluate, and Benchmark Staffing
Appendix E: Patient Progress Record: Care Coordination Assessment
Appendix F: CM Initial Assessment for Discharge Planning
Appendix G: ED References