Bedside Case Management

After completing this course you will learn to:

·  Determine if case management is a new model for the delivery of patient care.

·  Discuss the evolvement of case management.

·  Explain why the coordination of public services was set up.

·  Recognize what the community service focus centered on.

·  Discuss why the United States Public health Service designed an early case management system.

·  Identify the act that made funds available in the mid 1930s for the provision of meeting individual client health care needs.

·  Name the movement that had a major impact on the refinement of case management.

·  Recognize when the term ‘case management” first emerged in social welfare literature and practice.

·  Relate why Diagnosis-Related Groups (DRGs) were set up.

·  Explain what form of nursing case management emerged in the mid 1980s to deal with restraints imposed by DRGs and third party payer
     resource conservation requirements.

·  Discern whether managed care is a new concept.

·  Discuss what DRGs were designed to do.

·  Explain what the initial focus of the insurance industry was in the mid 1980s.

·  Define capitation.

·  Identify what the focus of health care is now.

·  Discuss how health care institutions survive.

·  Relate how the cost for technology is paid for.

·  Compare lengths of stay with patient acuities.

·  Determine how duplication and fragmentation of health care services are influenced by the changing health care delivery system of the
     1990s.
 
·  Recognize what the viability of health care institutions relies on.

·  Report what health care administrators have to do with finite resources in a limited reimbursement climate.

·  Define the goal of third party payer managed care.

·  Discuss what a primary care physician in a Health Maintenance Organization (HMO) is frequently charged with.

·  List the five HMO models.

·  Summarize the Individual Practice Associations’ (IPAs) policy on reimbursement for health care services performed by non-member
     providers.

·  Report why physicians and health care facilitators enter Preferred Provider Organization (PPO) health care contracts.

·  Validate why Point of Service (POS) plans use financial incentives.

·  Discuss one of the premises of unit-based managed care.

·  Recognize what critical pathways are used for in unit-based managed care.

·  Discuss utilization management with regard to to the quality of delivered health care services.

·  Recall why utilization management concepts were introduced.

·  Define severity of illness (SI).

·  List the tree components to the utilization review process.

·  Identify a good question to ask when doing a concurrent or continued stay review.

·  Relate how many health care disciplines incorporate some form of case management.

·  Recognize other terms for case management.

·   Identify how case management organizes patients.

·   Recall what advanced skills patient case managers possess.

·  Tell how many fundamental steps there are to the process of planning and establishing health care goals.

·  Discuss how patient involvement in care relates to the success of case management.

·  Differentiate between case management and bedside case management.

·  Indicate what the nursing process has fostered in the nurse and how thisrelates to the transition into case management.

·  Relate what the nurse case manager is held accountable for in bedside case management.

·  Describe the form of group practice that exists within bedside case management.

·  Discuss what the case management plan is used for in bedside case management.

·  Explain the importance of communication in the successful delivery of quality patient care.

·  Recognize the roles of the nurse case manager in a bedside case management approach to patient care.

·  Identify what approach is used to accomplish cost-effective, outcome oriented, quality patient care within the shared group practice
     framework of bedside case management.

·  Determine what the nurse case manager supervising a team must be aware of in order to judiciously delegatepatient care tasks.

·  Summarize points to cover in the change of shift report.

·  Discuss what happens during intra-shift report.

·  Discuss the use of patient care protocols.

·  Relate how bedside case management affects cooperation between the hospital-based patient care disciplines and the community health
     care agencies.

·  Describe the contents of the case management plan.

·  Summarize the affect of bedside case management on treatment, fragmentation of health care services, and health care service delays.

·  Report what the influence of bedside case management is on patient education.

·  Discuss what encouraging the patient’s participation in care activities does for the patient.

·  Recognize what bedside case management does for the nurse case manager.

·  Indicate what bedside case management does for the skill level of the patient care team members.

·  Discuss how bedside case management elicits physician satisfaction.

·  Select the focus of practice for the bedside case manager.

·  Summarize the qualifications the bedside case manager must inherently possess in order to orchestrate quality patient care that meets
     managed care dictates and requirements.

·  Identify clinical responsibilities of the bedside case manager.

·  Determine reasons the bedside case manager acts as a patient advocate.

·  Discuss the financial responsibilities of the bedside case manager.

·  Specify the learning needs of the new bedside case manager.

·  Identify when the use of critical pathways was developed originally.

·  Recognize the overall goals of a critical pathway.

·  Report the categories for which the clinical pictures of patients for whom critical pathways are developed fall into.

·  Identify variables that must be considered when developing a critical pathway.

·  Choose the categories that the processes and interventions of a critical pathway can be grouped under.

·  Relate how critical pathways affect patient care practices.

·  Identify how soon after admission the critical pathway chosen for thepatient has to be addressed with the patient’s physician(s).

·  Indicate what type of data critical pathways allow for the use of when determining goal evaluation.

·  List the components that protocols contain.

·  Recall the events that variances show can influence patient outcomes.

·  Describe what bedside case management does to the focus of quality improvement.

·  Discuss ways bedside case management improves the quality of patient care and the delivery of health care services.

·  Recall the types of patient care systems bedside case management provides for.

·  Indicate how bedside case management is similar to continuous quality improvement (CQI).

·  Define patient care standard outcome indicators.

·  Report at least four reasons bedside case management is instituted in acute care facilities.

·  Recognize the first step in the planning process before bedside case management can actually be instituted.

·  Determine the overall goal of the bedside case management institution task force.

·  Summarize ways to encourage physician participation in the institution of a bedside case management model of patient care delivery.

·  Recall responsibilities that the bedside case manager will be held accountable for.

·  Relate what must be assessed before instituting a bedside case management patient care delivery model.

·  Indicate what the nurses who take on the bedside case manager role will need to know how to do.

·  Identify during which phase the process for evaluating bedside case management must be developed.

·  Discuss what connection nursing case management will have the ability to promote.

·  Relate what case management practice will be molded by in the twenty-first century.

·  Recognize what it will be necessary for case management programs to do as the population of the United States grows older.

·  Identify two relatively new case management programs that nurses will probably become even more involved with.

Contents