Five elements are essential to successful implementation of case management:
● Support by key members of the organization (administrators, physicians, nurses) ● A qualified nurse case manager ● Collaborative practice teams ● A quality management system ● Established critical pathways (see next section)
In case management, all professionals are equal members of the team; thus, one group does not determine interventions for other disciplines. All members of the collaborative practice team agree on the final draft of the critical pathways, take ownership of patient outcomes, and accept responsibility and accountability for the interventions and patient outcomes associated with their discipline. The emphasis must be on managing interdisciplinary outcomes and building consensus with physicians. In addition, outcomes must be specified in measurable terms.
Critical Pathways Successful case management relies on critical pathways to guide care. The term critical path, also called a care map, refers to the expected outcomes and care strategies developed by the col- laborative practice team. Again, interdisciplinary consensus must be reached and specific, and measurable outcomes determined.
Critical paths provide direction for managing the care of a specific patient during a specified time period. Critical paths are useful because they accommodate the unique characteristics of the patient and the patient’s condition. Critical paths use resources appropriate to the care needed and, thus, reduce cost and length of stay. Critical paths are used in every setting where health care is delivered.
A critical path quickly orients the staff to the outcomes that should be achieved for the patient for that day. Nursing diagnoses identify the outcomes needed. If patient outcomes are not achieved, the case manager is notified and the situation analyzed to determine how to modify the critical path.
Altering time frames or interventions is categorized as a variance, and the case manager tracks all variances. After a time, the appropriate collaborative practice teams analyze the vari- ances, note trends, and decide how to manage them. The critical pathway may need to be revised or additional data may be needed before changes are made.