How Case Management Can Improve the Quality of Patient Care

Abstract

In January 1993, The New York Hospital Medical Center of Queens, a 487 bed acute care teaching hospital, created a Case Management Department to provide quality health care for patients that was cost efficient and at the same time reduce length of stay. Registered nurses with extensive medical and surgical expertise who were quality assurance/utilization coordinators and discharge planning nurses were cross-educated to become patient case managers. The case manager coordinates patient care services to improve the quality of the total patient experience. Reviews are conducted daily. The case managers indicate quality issues on their computer worksheets. Quality concerns are addressed and referrals made to the QA Department. Case Management Team rounds are conducted on the patient unit to discuss quality issues and barriers to discharge. Many delays were noted in patient care services i.e. Physical Therapy (P.T.) and Radiology. Readmissions within 48 hours of discharge were noted and reviewed as an indicator to monitor outcome and quality concerns. Continuous Quality Improvement (CQI) projects were initiated to reduce patient care delays. Multidisciplinary teams were formed to expedite solutions. The number of P.T. and Radiology delays were dramatically reduced through the CQI process. The case manager's role is vital to the delivery of quality patient care and containment of ever spiraling health care costs.