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Case management models in the acute care setting are constantly evolving and improving. So is true for case management in the emergency department. RN and Social Work case managers working in this fast-paced setting must evaluate patients who will be treated and released, those being placed into observation and those being admitted to an inpatient bed.
Therefore, it is imperative that the ED case management model is consistent with the inpatient model but yet applied differently in order to address these categories of patients.
The ED case management professional must learn how to “triage” large numbers of patients, many of whom may need a case management intervention. In addition, EMTALA (The Emergency Medical Treatment and Active Labor Act) guidelines and rules must be obeyed and the Value-Based Reimbursement metrics must be considered.
We will discuss the structure of a best-practice ED case management model as well, and the processes the roles should follow. We will conclude with outcome measures for ensuring that your ED program is making a difference for your organization!
Whether you work in the ED or not, you need to understand this important and critical role as it interfaces with every other case management professional in the acute care setting.
Large numbers of patioents enter via the ED and may need a clinical review , a discharge plan or coordination of their care. In addition, some may need the support or help of a social worker. Unit-based case managers and social workers will also benefit greatly from the work completed in the ED as the patient’s time spent there is optimized.
This program will help you to understand how to imbed case management in the ED and what that means for the entire case management department.
Toni G. Cesta, Ph.D., RN, FAAN is Partner and Health Care Consultant in Case Management Concepts, LLC, a consulting company which assists institutions in designing, implementing and evaluating acute care and community case management models, providing on-site education to case management staff, and strategies for assisting health care organizations in improving their case management department’s efficiency and effectiveness.
The author of nine books, and a frequently sought after speaker, lecturer and consultant, Dr. Cesta is considered one of the primary thought leaders in the field of case management.
Dr. Cesta writes a monthly column called “Case Management Insider” in the Hospital Case Management journal in which she shares insights and information on current issues and trends in case management.
Prior to her current work as a case management consultant, Dr. Cesta was Senior Vice President – Operational Efficiency and Capacity Management at Lutheran Medical Center in Brooklyn, New York. She was responsible for case management, social work, discharge planning, utilization management, denial management, bed management, the patient navigator program, the clinical documentation improvement program and systems process improvement. Prior to her position as Senior Vice President at Lutheran Medical Center, Dr. Cesta has held positions as Corporate Vice President for Patient Flow Optimization at the North Shore – Long Island Jewish Health System and Director of Case Management, Saint Vincents Catholic Medical Centers of New York, in New York City and also designed and implemented a Master’s of Nursing in Case Management Program and Post-Master’s Certificate Program in Case Management at Pace University in Pleasantville, New York. Dr. Cesta completed seven years as a Commissioner for the Commission for Case Manager Certification.
Dr. Cesta has presented topics on case management at national and international conferences and workshops. Her books include “Nursing Case Management: From Essentials to Advanced Practice Applications”, “The Case Manager’s Survival Guide: Winning Strategies in the New Healthcare Environment”, “The Case Manager’s Survival Guide: Winning Strategies for Clinical Practice”, “Survival Strategies for Nurses in Managed Care” and “Core Skills for Hospital Case Managers”.