Practice partnerships.:DELIVERING NURSING CARE
CHAPTER 3 • DELIVERING NURSING CARE 35
In an acute care setting, the case manager has a caseload of 10 to 15 patients and follows patients’ progress through the system from admission to discharge, accounting for variances from expected progress. One or more nursing case managers on a patient care unit may coordi- nate, communicate, collaborate, problem solve, and facilitate patient care for a group of patients. Ideally, nursing case managers have advanced degrees and considerable experience in nursing.
After a specific patient population is selected to be “case managed,” a collaborative prac- tice team is established. The team, which includes clinical experts from appropriate disciplines (e.g., nursing, medicine, physical therapy) needed for the selected patient population, defines the expected outcomes of care for the patient population. Based on expected patient outcomes, each member of the team, using his or her discipline’s contribution, helps determine appropriate interventions within a specified time frame.
To initiate case management, specific patient diagnoses that represent high-volume, high- cost, and high-risk cases are selected. High-volume cases are those that occur frequently, such as total hip replacements on an orthopedic floor. High-risk cases include patients or case types who have complications, stay in a critical care unit longer than two days, or require ventilatory support. Patients also may be selected because they are treated by one particular physician who supports case management.
Whatever patient population is selected, baseline data must be collected and analyzed first. These data provide the information necessary to measure the effectiveness of case management. Essential baseline data include length of stay, cost of care, and complication information.