The hospitalist should expect that high level of competency from a case manager, just as the case manager should be able to expect the highest competency of the hospitalist. “The hospitalist should not lessen their expectation of the clinical competency of the case managers,” says Cunningham. “We are advocating that the physicians … increase their expectations of the clinical competency of those individuals.”
Cunningham recommends that hospitalists discuss their case manager’s background if they suspect there is a diminished competency. “Competent case managers “not only make it better for patients,” he says, “but practitioners’ lives are made much easier when competent case managers are hired.”
All the case managers at Cabrini Hospital have a strong clinical background. “It is really important that the case managers are competent in the field they are working in,” says Brocato, “so that the physicians can trust that they understand the clinical side as well as what might be needed at discharge planning. [At Cabrini Hospital] they are placed in the units where they work based on their careers as nurses. The case manager that works in ICU, for instance, was an ICU nurse for many years.”
Brocato believes “hospitalists need to feel confident that the case managers—or discharge planners as they’re called at some hospitals—have a strong clinical background. In that way, when the hospitalists “are discussing their cases, they feel that we know what they’re talking about. For us, it means that we feel we are all on the same page when we’re dealing with the physicians so that we know what the course of treatment will be. Then the case managers are able to make a better discharge plan based on what the expectations of the hospital stay are going to be, so we can plan ahead.”
Dr. Weisul, who oversees three healthcare facilities in the central Louisiana region, knows that the relationship between hospitalists and case managers can be a fruitful one for all concerned. Cabrini has achieved the lowest case mix-adjusted length of stay in its healthcare system. In addition, when physicians were surveyed regarding the discharge planning process provided to their patients, the hospital achieved a combined rate of 97% “satisfied” or “very satisfied.”
“The idea that case management can achieve, with the physician, a low length of stay does not necessarily have to be in an environment of contention,” says Dr. Weisul.
Realize that case managers are there to assist hospitalists meet patients’ care goals. Watch for patients who a need longer length of stay and alert case managers in those cases to ensure moving them to appropriate levels of care, such as long-term acute care setting as soon as possible. Let case managers know how patients and families can reach you post-discharge. Expect the highest standard of competency from case managers and work with hospital administrators and case management to consistently make this a reality. TH
Andrea Sattinger writes regularly for The Hospitalist.
- Palmer HC Jr, Armistead NS, Elnicki DM, et al. The effect of a hospitalist service with nurse discharge planner on patient care in an academic teaching hospital. Am J Med. 2001;111:627-632.