Bedside case management is advantageous to the patient, the physician(s), the other health care disciplines caring for the patient, the nurse case manager, the patient care team, and the health care institution at which the patient is receiving care. Bedside case management promotes:

·     Efficient achievement of standardized patient outcomes.

·     Collaboration among health care disciplines.

·     Coordinated continuity of patient care.

·     Appropriate or reduced utilization of resources.

·     The facilitation of timely patient discharge.

·      Patient satisfaction.

·     Nurse case manager satisfaction and professional development.

·     Patient care team satisfaction.

·     Physician satisfaction.

          Bedside case management provides for the uniform treatment of cases by having standardized case management plans/critical pathways for diagnosis groups and by utilizing patient care protocols. The case management plans/critical pathways outline for the patient and everyone caring for the patient the daily activities that need to be accomplished and the expected clinical milestones that have to be reached and, in some institutions, provide for a streamlined yet more thorough documentation system. Vautier and Carey (1996) note that at Crawford Long Hospital of Emory University using the collaborative critical pathways as documentation tools “…reduced duplication in charting and improved documentation of desired patient outcomes”.

           Patient care protocols ensure that every patient comes with a set of basic care instructions that structure the patient care team’s approach to procedure performance according to facility policy. Patient care protocols provide less chance for departure from recognized practice standards; thus, the margin for error and patient complications is reduced (Rawsky, 1996).

          Bedside case management improves patient outcomes by expediting early recognition of deviations from the standard case management plan and timely initiation of relevant interventions (Milne & Pelletier, 1994). Early deviation recognition with expedient intervention initiation also helps to reduce the patient readmission rate. The most dramatic impact of bedside case management is seen with patients who have multiple complex diagnoses (Coleman & Zagor, 1998). Bedside case management requires that treatment issues are addressed in a timely manner by a quality-conscious patient care team; thereby, improving the quality of patient care and linking it to continuous quality improvement (CQI) activities making it easier to identify system improvement opportunities.

          Bedside case management evokes and supports a collaborative, non-hierarchical group practice between the physician(s), the nurse case manager, and the other health care disciplines caring for the patient. According to Adams and Renfro (1991) as sited in Christensen and Bender (1994), “As implemented in some institutions, case management has strengthened nurse/physician collaboration…”. Bedside case management also encourages cooperation between the hospital-based patient care disciplines and the community health care agencies facilitating continued care for the patient. The professional network that evolves between all the health care disciplines provides for the effective mobilization of health care resources to meet patient needs (Ritter et al, 1992).

          Bedside case management opens the lines of communication by providing increased opportunities for the physician(s), the nurse case manager, the patient and the patient’s support person(s), the patient care team, and the other health care disciplines caring for the patient to meet both formally and informally to outline patient care and discuss the patient’s progress and discharge planning/continued care needs (Milne & Pelletier, 1994). Bedside case management combines what used to be several different plans of care into one multidisciplinary case management plan that contains mutually agreed upon patient care goals. In this way, each health care discipline is cognizant of the other’s patient care interventions and is conscious of how those interventions may affect the patient’s progress and each discipline’s patient care. Bedside case management supports a decrease in the fragmentation of provided health care services and allows for improved planning based on the accessibility of diverse perspectives with regard to patient care (Roberts-DeGennaro, 1993).

          Bedside case management improves supply, equipment, treatment, procedure, personnel, and capital resource utilization by predicting resource consumption based on the established treatment standards for diagnosis groups (Cohen & Cesta, 1994). Bedside case management orients the nurse case manager to the financial perspective of patient care and educates hospital administration about the patient’s clinical picture. By familiarizing the nurse case manager with the financial aspects of patient care and by themselves knowing the patient’s clinical status, hospital administration can be assured that the staff who are providing patient care are doing so in the most proficient, quality-oriented, cost-effective way possible. “Clinical RNs’ contributions to case management and utilization practices resulted in significant financial savings to Logan Regional Hospital” (Bair et al, 1989). At Candler County Hospital in Georgia, instituting bedside case management produced “…an estimated cost savings of $65,932…for the 16-month study period” (Anderson-Loftin et al, 1995), and after the institution of bedside case management at Frye Regional Medical Center in North Carolina “annual expenses have been reduced by over $200,000…” (Johnson & Proffitt, 1995). Once bedside case management was in place, Good Samaritan Hospital in Cincinnati, Ohio showed a cost savings of $94,159 over a 9-month period (Galvin & Baudendistel, 1998,). Johns Hopkins Hospital in Baltimore, Maryland saw a cost reduction in patient charges of $1.3 million in the cardiac surgery program after bedside case management was incorporated into patient care, exceeding the institution’s target savings estimation of $826,000 by a large margin (Walrath et al, 1996).

          Improving resource utilization and having a knowledgeable administration and an informed patient care team also helps the hospital accommodate an increased number of managed care contracts and further sharpens the hospital’s competitive edge in a tight third party payer-run health care market. Bedside case management encourages uniform treatment, decreases fragmentation of health care services, and decreases health care service delays. It also links resource expenditures to the actual care provided. Furthermore, bedside case management assists the institution in designing an efficient staffing pattern for the patient care team; thus, significantly decreasing overtime hours permitting the patient care team to function within the prescribed budget (Chimner & Easterling, 1993).

          Bedside case management expedites the patient’s discharge within or before the duration of time set for the appropriate length of stay with fewer last minute discharge problems. Bedside case management also makes possible appropriate planning for post-discharge care. At Candler County Hospital, bedside case management “…has been associated with a decrease in the (average) length of stay by 1.7 days…” (Anderson-Loftin et al, 1995). After the institution of bedside case management at Frye Regional Medical Center, the length of stay for patients who have undergone total knee replacement surgery has decreased by 21%, and the length of stay for patients who have undergone total hip replacement surgery has been reduced by 15% (Johnson & Proffitt, 1995). Vautier & Carey (1994) note that after the establishment of bedside case management at the Crawford Long Hospital of Emory University the average length of stay for all patients was reduced, and at Carondelet St. Joseph’s Hospital in Tucson, Arizona bedside case management facilitated an overall length of stay decrease from 9 to 6 days (Mahn, 1993, p. 48).

          Bedside case management further facilitates the timely movement of the patient through the system by increasing the frequency and amount of patient education. By having specific patient education goals tied into the case management plan and by requiring that essential patient education begin on admission and continue at appropriate intervals during the patient’s hospitalization, bedside case management successfully decreases the patient’s length of stay.

          One way bedside case management improves the care satisfaction of the patient and the patient’s support person(s) is by heightening their clinical and financial awareness with regard to hospitalization and recovery. After the organization of bedside case management at Carondelet St. Joseph’s Hospital, “…hospital staff in the admitting and preoperative holding areas reported patients appeared to be less anxious and more aware of their hospital experience” (Mahn, 1993). Also, by helping the patient be more knowledgeable about health care options and the financial aspects tied to those options, bedside case management can increase the patient’s access to health care services. Bedside case management also provides coordination of patient care from one level of care to another, keeping the patient and the patient’s support person(s) informed of needed changes.

          What’s more bedside case management allows for an improved patient education program. An improved patient education program helps to increase the patient’s knowledge with regard to the disease process, self-care, recovery, and wellness, which can lead to increased feelings of relief and confidence in the patient. Bedside case management correspondingly encourages participation in the patient’s care by the patient and the patient’s support person(s), instilling satisfaction and a sense of ownership with regard to the case management plan. Vautier and Carey (1996) note that at Crawford Long Hospital of Emory University “patient interviews continue to reveal that family involvement in care planning, quality and continuity of services, collaboration between providers, and satisfaction with care received are rated at high levels” . Bedside case management instills a feeling of open communication in the patient and the patient’s support person(s). “…Patients report that the daily gathering of all providers around the bed is a great comfort, signifying to them that care is organized and well planned” (McHugh et al, 1996). Bedside case management keeps the patient and the patient’s support person(s) informed of the patient’s progression; thus, decreasing anxiety and complaints and improving overall patient progress (Chimner & Easterling, 1993; Goode, 1995). The patient is also more satisfied with bedside case management because individual needs are met more quickly (Bayard et al, 1997).

          Bedside case management increases the nurse case manager’s job satisfaction and encourages professional development and accountability (Nugent, 1992; Goode, 1995). Bedside case management allows the nurse case manager to experience empowerment and a sense of self-actualization. The use of management skills such as coordinating, giving direction, delegation, and controlling by the nurse case manager in bedside case management, strengthens the nurse case manager’s autonomy and professional recognition (Ritter et al, 1992; Goode, 1995). “The recognition and collegial relationship that develops with physicians as they collaborate to achieve patient outcomes is very satisfying (for the nurse case manager)…The full spectrum of the management of patient care, with its clinical and financial components, is truly actualized in this (nurse case manager) role” (Ritter et al, 1992).

          Bedside case management increases the nurse case manager’s affective and cognitive skills (Milne & Pelletier, 1994). In bedside case management the nurse case manager takes an active role in the formulation of critical pathways/case management plans, experiences an increased opportunity for decision making, and encounters decreased documentation requirements. All of these add to the nurse case manager’s professional skill development (Strzelecki & Brobst, 1997). According to Adams and Renfro (1991) as sited in Christensen and Bender (1994), “…case management has strengthened…nurse management of patient care”.

          Because a greater control over practice is assumed, bedside case management helps to decrease burnout and absenteeism in the nurse case manager (Roberts-DeGennaro, 1993). Along with improving recruitment of new nurse case managers, bedside case management promotes nurse case manager retention. At St. Joseph Mercy Hospital in Pontiac, Michigan, registered nurse staff turnover on the rehabilitation unit decreased 17.4% after implementation of bedside case management (Chimner & Easterling, 1993).

          The increased communication and acceptance of input by all members of the patient care team that bedside case management fosters, increases the job satisfaction of the members on the patient care team. The patient care team members appreciate having accessible resources with whom they can readily problem solve (Chimner & Easterling, 1993). Bedside case management increases the skills of the patient care team members, most notably assessment and psychosocial skills (Milne & Pelletier, 1994).

          Bedside case management decreases patient care team member absenteeism and improves recruitment and retention of team members. The decrease in overtime hours and documentation that bedside case management brings with it also serves to increase patient care team satisfaction (Chimner & Easterling, 1993).

          Bedside case management elicits physician satisfaction by decreasing the demanded time needed for problem solving and by increasing patient satisfaction with regard to quality care. Bedside case management also decreases physician inconvenience, reduces individual patient case workload, and improves the ability to meet schedules and deadlines; thus, permitting more productivity time and service to a higher volume of patients. Physicians appreciate the more efficient discharges and decreased lengths of stay made possible by bedside case management. Bedside case management fosters in the physician a sense of confidence with respect to how patient care is managed and instills a sense of enthusiasm for physician-nurse collaboration (Milne & Pelletier, 1994). “Nursing staff has a better understanding of patient problems and follows through with solutions more consistently and…(there is) an improvement in (patient care) team functioning…” (Chimner & Easterling, 1993). McHugh et al (1996) write, “Physicians report that incorporating the nursing perspective on rounds has been invaluable to them in ensuring that care plans are realistic and reasonable”.

          Bedside case management has made a positive, direct impact on patient care delivery. The benefits of bedside case management are numerous. They traverse across all disciplines caring for the patient, incorporate the patient, and show up as cost savings and reduced lengths of stay. Bedside case management, with the assistance of third party payer requirements, creates a mutual understanding between the health care disciplines caring for the patient and the patient. Bedside case management integrates quality patient care with cost containment and patient, staff, and physician satisfaction. This is important because in today’s health care environment, the patient is taking a more active role in care planning and the health care disciplines caring for the patient are realizing the patient’s goals must be harmonious with their own in order to achieve desired outcomes within a targeted or reduced length of stay.

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