http://www.aboutjoints.com
| CASE MANAGEMENT |


History

During the early 1980ís the hospital length of stay for a patient undergoing a total hip or total knee surgery was fourteen days. Length of stay for patients having revision surgery was even longer. Insurance companies usually paid in full for these hospitalizations, and as hospital costs continued to mount, it became apparent that changes in hospital insurance and patient care policies were necessary. With physical therapy, occupational therapy, dressing changes, and other treatments being available in either the patientís home or an outpatient setting, the push to reduce hospital length of stay intensified.

In response to this, the Division of Arthritis Surgery, under the direction of David S. Hungerford, M.D., initiated in 1989 the position of orthopaedic nurse coordinator. Functioning as a patient advocate and providing patient education were the primary goals of the nurse coordinator. Established to assist the patient, hospital, and physician, this position became the model for the development of the case management program, which was instituted hospital-wide several years later. Within the first two years of beginning our program, the length of stay for our total joint patients had been decreased to 8 days hospital stay. More importantly, this decrease in hospital stay was made while maintaining optimum patient care. Today, the length of hospital stay for patients having joint surgery is four days. Case management continues to play an active role in assisting the patient, hospital and physician to achieve the most efficient and beneficial care possible. Currently, the case management department is hospital-wide and is composed of thirty staff members including social workers, R.N. case managers, and utilization review personnel.

[TOP]

Goals

The goals of case management are to:

    • Provide the highest level of patient care in the most cost-effective manner possible.

    • Improve coordination and efficiency of the patientís surgical experience- pre-operatively, during hospitalization, and after discharge.

    • Provide the patient with the proper monitoring needed post-operatively to assure optimum care in the hospital.

    • Assist in establishing any services needed in transferring the patient from an inpatient care status to an outpatient (home) care status.

    • Assure proper follow-up of the patient during the post-discharge phase, detect any problems, and treat those problems as necessary.

    [TOP]

Patient Contact

If you have scheduled surgery with one of our physicians, you will have a case manager who will follow your case pre-operatively, during your hospitalization, and after you are discharged home.

Pre-Operative Phase

THE PRE-OPERATIVE PHASE IS ONE IN WHICH THE EMPHASIS IS PLACED ON PLANNING, EDUCATION, AND CAREFUL ESTABLISHMENT OF A CONTACT PERSON TO ASSIST THE PATIENT IN ALL ASPECTS OF HIS/HER CARE.

Initial contact with the case manager occurs at the time of scheduling surgery or by telephone prior to admission. The purpose of this contact is to assess the patientís functional status, home environment, and available assistance. In addition, a brief medical and surgical history, a listing of medications, and demographic information is obtained. By conducting the pre-operative interview, the patient is introduced to a contact person for himself and family members. Any questions, problems, or concerns can then be brought to the case managerís attention throughout the pre-operative phase. If any need for referrals to social services, a rehabilitation facility, or home care are identified during this time, they can either be initiated or noted for reference when the patient is admitted to the hospital. In addition, the pre-operative phase includes inviting and encouraging the patient and family members to attend a pre-operative class concerning total joint surgery. These classes are held weekly and alternate between discussion of total hip and total knee surgeries. Pre-op Class Information.

Hospitalization Phase

DURING HOSPITALIZATION PHASE EMPHASIS IS PLACE ON MAINTAINING AND ADJUSTING THE PRE-OPERATIVE DISCHARGE PLANS AND PROVIDING ACCESS TO HOME CARE NEEDS IN A SAFE AND TIMELY FASHION.

During this phase, the case manager follows the patient and reviews the prior to discharge planning with the patient, physician, and other hospital personnel. Any adjustments to the original plan or referrals to other areas are then made. The case manager will be overseeing the discharge plans and coordinating any post discharge services required by physical therapy, nursing, or other home care programs. It is also during this phase of interaction that the patient is given instructions regarding scheduling follow-up appointments and the reporting of post-discharge problems directly to the case manager. Follow-up appointments and signs and sypmtoms to report post-op.

Post Discharge Phase

EMPHASIS DURING THE POST DISCHARGE PHASE IS PLACED ON FOLLOW-UP CARE, MAINTAINING CONTACT, AND EARLY INTERVESTION IN THE EVENT OF ANY POST DISCHARGE PROBLEMS.

The case manager contacts each of our patients within 48-72 hours after discharge. The patient is contacted for the purpose of evaluating his/her status and adjustment to home. Specific questions are asked to assess progress, assistance, pain levels, wound status, and physical therapy instructions. If any problems are identified, the case manager either resolves them or refers them for physician instructions. The case manager also reinforces with the patient previous discharge instructions and the importance of reporting any problems or questions regarding the post-discharge period. It is during this time that the case manager also verifies or assists the patient in making their first follow-up appointment and maintains further patient care by doing so.

[TOP]

Our Commitment

The Division of Arthritis Surgery has been and will continue to be committed to improving the efficiency and coordination of the orthopaedic patientsí care from the outpatient setting to the hospital and back to the home environment. It is our belief that through the case manager/patient relationship these goals can be achieved safely, effectively, and in a timely manner.

[TOP]