Bedside Case Management
After completing this course you will learn to:
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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.
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