Case Management – Collaboration (Nursing)

00:00 Welcome back everyone. Healthcare services are continually evolving and increasingly difficult to navigate for even the most informed consumers. For those patients with complex health problems, it becomes even more challenging and confusing to know what resources are available or who to go to for care. One service which may help patients overcome this challenge is case management.

00:23 Case management is a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual's and family's comprehensive health needs through communication and available resources to promote patient safety, quality, cost effective outcomes. The registered nurse as a case manager entails the coordination of care, resource identification, the planning of services, referrals and linking clients to the services that they need based on their biological, emotional, and social needs as well as their spiritual and cultural preferences. When nurses function as case managers, they ensure that client care is high quality, effective, timely, complete, and cost effective. They also ensure that all clients are provided with the care and services offered by not only the appropriate members of the nursing care team, but also with members of the multidisciplinary healthcare team. They ensure that all clients are provided with the material resources they need to meet their current assessed needs. They coordinate and continuously evaluate the timeliness, effectiveness, and appropriateness of client care. They identify and implement immediate and effective actions if and when any deviations in the plan of care and/or poor patient outcomes occur. And finally, they ensure that the client is at or move to the appropriate level of care. Now case management can employ a number of different frameworks and models. These possible case management models used for patient care delivery systems include the ProACT Model. The professionally advanced care team assigns and addresses the registered nurse's role as both the primary nurse providing clinical care and a clinical case manager with additional formal functions such as those related to personnel, physical and budgetarian responsibilities, and administration or management functions.

02:14 The Collaborative Practice Model of case management entails the role of some registered nurses in a particular healthcare facility to manage, coordinate, guide, and direct the complex care of a population of clients throughout the entire healthcare facility. We share a particular diagnosis or diagnostic related group referred to as a DRG such as chronic obstructive pulmonary disease or an acute myocardial infarction. The Case Manager Model is quite similar to the Collaborative Practice Model with the exception that in this model, unlike the Collaborative Practice Model, it's unit based and not organizational ___. And finally, the Triad Model of Case Management creates, maintains, and focuses on the close interdisciplinary collaboration of the social worker, the nursing case manager, and the utilization review team members throughout the course of care.

03:04 Now common case management activities might include identification and screening, assessment, needs identification, planning, service and product acquisition and implementation of those services, coordination of care, and of course ongoing monitoring. Now here is a great example. As a registered nurse, you are serving as a case manager at a local hospital. Now you've been asked to present information about the role of the case manager to the orientation class of new registered nurses. Which of the following is a primary case management responsibility that is associated with reimbursement? Would it be organization-wide performance improvement activities; complete timely and accurate documentation; the client being at the appropriate level of care; or would it be contesting, denied, reimbursements? It would be the client being at the appropriate level of care. Think about this example. If a case manager has been working with the patient who had been admitted for a total knee replacement and the case manager had determined that the patient was ready to be moved to rehabilitation center, it would be more cost effective for the organization if the patient was transferred when ready rather than any delay discharge because that would cost the organization more money unnecessarily. So remember, case managers are the professionals most aware of the patient's functional, physical, cognitive, emotional, and socio-economic abilities and they know best how these abilities might affect and determine a patient's level of functioning after discharge or transition from an acute care setting or an episode of illness. So, in thinking of what we've covered today, I'd really like for you to consider this question. What are 7 common activities case managers perform? They perform identification and screening, assessment, needs identification, planning, service and product acquisition and implementation, coordination of care, and of course ongoing monitoring. I hope you've enjoyed today's video on Case Management in Nursing. Thank you so much for watching.