Provider services and solutions

Clinical operations & quality: Clinical care & case management

The challenge

When high patient volume strains a hospital’s capacity, patient care can suffer. Patient tracking becomes haphazard, throughput slows, operating inefficiencies that usually go unnoticed develop into serious problems, patient stays lengthen, test and lab results are delayed, patient dissatisfaction rises and claims are denied. The cure for these ills: effective case management. Streamlining or reforming your case management processes can improve the quality of your hospital’s clinical care, expanding capacity and boosting revenue.

Good case management can be difficult to achieve in the often-chaotic environment of a busy hospital, especially in the emergency department, where tracking patients and their needs is most critical. Smooth patient throughput requires clear delineation of responsibilities among administrative and clinical staff. Open lines of communication. Better collaboration. Thinking about patient care as a continuum of services rather than a series of stand-alone services. Revamping your case management will mean making substantial changes to longstanding clinical, operational and administrative processes.

How we can help you

• Case management is effective only when clinicians and administrative staff know their jobs and work closely together.
  • We can help you untangle lines of communication among clinical and administrative staff. Evaluate job functions and define responsibilities for staff with case-management roles.
• Most patients enter your hospital through the emergency department, where information can easily slip through the cracks.
  • We can work with you to create an emergency department case management process to determine the medical needs of new admissions and ensure correct patient status.
• Efficient admission and discharge practices accelerate patient throughput and enhance revenue.
  • We can help you develop efficient preadmission, admission and discharge practices to meet coding, billing and regulatory requirements.

Common services include

• Improving bed management, bed turnaround, and patient discharge practices in nursing units
• Assessing and enhancing physicians’ roles in admissions and discharges
• Creating a denials appeal program