Abstract
This paper will present an implementation plan for case management protocol. It will propose an approach to gain buy-in from key stakeholders in the plan, and it will work to define and examine the key outcomes of the case management protocol plan. Through a detailed analysis of what the proposed protocol entails, how it should be implemented and what its outcomes will be, the buy-in from stakeholders in the plan itself should speak for themselves.
Keywords: implementation plan, stakeholders, case management protocol
Implementation Plan for Case Management Protocol
Purpose
The Case Management Protocol described herein is designed to work to decrease errors associated with patient assignations through the process of ensuring the correct patient status is assigned to the patient, decreasing billing errors and clerical errors that may otherwise result from incorrectly identifying a patient’s status as inpatient, observation, or outpatient (FMQAI, 2006). In addition, the Case Management Protocol described herein is designed to work to decrease diabetes complications as a result of poor glycemic control (Watts, Lawrence & Kern, p. 25). This method of intervention using case management works to improve glycemic control in patients with Type II Diabetes
Approved Standing Order
It is proposed that the Case Management Protocol be implemented after being approved by the case management department of the facility. The Case Management Protocol described herein should be implemented as a standing order for every patient, regardless of their payment status and should be used as the patient status both for initial determination and updated on an as needed basis with indications as to the reason for status change. I.E. if a patient is held for observation and then later admitted, the status should be changed and the date and time the status was changed should be notated along with the reason for the status change itself. It is important to note that the admission status will not affect the plan of care generated by the physicians; it will simply serve as a means of identification for the case managers, administrative staff and billing staff (HCPro, 2011).
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It is proposed that the Case Management Protocol be implemented after being approved by the case management department of the facility. The Case Management Protocol described herein should be implemented as a standing order for every patient with Type II Diabetes, regardless of their payment status and should be updated on an as needed basis through chart notations. I.E. if a patient is experiencing issues with glycemic control, it should be documented as to the reasons why and the method used to address those reasons. If the patient has no glycemic control issues but develops those issues during their stay, the reason for the occurrence should be noted. It is important to note that the inclusion of this information will not necessarily affect the plan of care generated by the physicians; it will simply serve as a means of identification for the case managers and healthcare providers (HCPro, 2011).
Implementation
It is imperative for implementation that a clear time line is established in order to ensure that all members on the team are ready and able to implement the program on the start date (CAMH, 2009). The first person that the patient will see will be the physician. The physician will review the status of the patient, determining whether they may be treated and released (outpatient), if they need to be kept for observation, or if the patient needs to be admitted into the hospital. The physician will write down their determination on the paperwork, with an order to assign status by Case Management Department. The case management department will have twelve hours to review the paperwork and make the determination as to if this will be the patient’s admitting status (FMQAI, 2006). If the physician disagrees with the status determination made by the case management department, the physician must find time to speak with the case management department regarding the determination. If the status is not determined within the allocated amount of time the patient will be assigned the status of “default” and must be changed after the fact with a signed physicians order detailing the date, time, and reason for the status change (FMQAI, 2006).
It is imperative for implementation that a clear time line is established in order to ensure that all members on the team are ready and able to implement the program on the start date (CAMH, 2009). The first person that the patient will see will be the physician. The physician will review the status of the patient, determining whether or not they have issues with glycemic control as a result of their diagnosis of Type II Diabetes. The physician will write down their determination on the paperwork, with an order to Review by the Case Management Department. The case management department will have twelve hours to review the paperwork and make the determination as to whether or not this may affect the patient’s plan of care. If the physician disagrees with the status determination made by the case management department, the physician must find time to speak with the case management department regarding the determination. If the status is not determined within the allocated amount of time it must be changed after the fact with a signed physicians order detailing the date, time, and reason for the change (FMQAI, 2006).
Outcomes
By working to implement this case management protocol it should work to reduce the amount of time spent on clerical errors, decrease errors in billing, cause an increase in efficiency within the administrative staff and billing staff, and work to reduce the amount of discrepancy within the paperwork.
By working to implement this case management protocol it should work to reduce the amount of time spent on potential issues that the patient with Type II Diabetes may face during or following their hospital stay. In addition, this may work to decrease the likelihood that the patient will need to be admitted on a future date for glycemic control issues.
Stakeholder Acceptance/Buy-in
Stakeholders include the patients, the physicians, the case management team, the owners and operators of the facility, the administrative staff, nursing staff, and billing staff. All associated parties should be more than willing to accept the implementation of this policy as it works to resolve a specific need that is not currently being met and costs no additional money to implement. Furthermore, it works to streamline the process for all administrative staff, allowing for increased efficient while working to appease the patients and the owners alike as it reduces the amount of billing errors present.
Stakeholders include the patients, the physicians, the case management team, and the nursing staff. All associated parties should be more than willing to accept the implementation of this policy as it works to resolve a specific need that is not currently being met and costs no additional money to implement. Furthermore, it works to decrease the likelihood of the patient returning to the hospital, makes the staff aware of any future issues that may arise, and decreases the likelihood of the patient’s return to the facility, thereby allowing all associated stakeholders to benefit from the change to the case management protocol. It allows the patients to remain healthier, makes less work for the doctors and nurses by decreasing the likelihood of an issue, and allows case management to ensure that they are doing their jobs to the fullest of their ability.
Conclusion
By working to implement these Case Management Protocols it is anticipated that the issues that have been identified and addressed herein will be able to be resolved in a simplified and timely manner, providing satisfaction for all stakeholders involved.
- CAMH. (2009). Develop an implementation plan. Retrieved from http://knowledgex.camh.net/policy_health/substance_use/mmt_community_guide/pages/develop_implementation_plan.aspx
- FMQAI. (2006). Fmqai’s case management protocol. Retrieved from www.gnyha.org/6941/File.aspx
- HCPro. (2011, February 23). Mentor moment: Case management protocol is still debatable. Retrieved from http://www.hcpro.com/CAS-262906-2278/Mentor-moment-Case-management-protocol-is-still-debatable.html
- Watts, S., Lawrence, R., & Kern, E. (2011). Diabetes nurse case management training program: Enhancing care consistent with the chronic care and patient-centered medical home models . Clinical Diabetes, 29(1), 25-33. doi: 10.2337/diaclin.29.1.25
