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The role of the social worker in the acute care setting has been evolving for the last two decades.
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A Hartford (CT) Physician Hospital Organization's program to reduce the rate of readmission for patients discharged with a primary diagnosis of heart failure has kept the readmission rate at between 11% and 13% for the last year, according to Linda Conroy, RN, BSN, clinical integration case manager for the Hartford Physician Hospital Organization, a partnership between Hartford Hospital and Hartford Physicians Association.
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Getting an entire staff of physicians, nurses, and techs to do things differently is never easy, but you can clear away hurdles by giving them the ability to formulate some of their own solutions. That, at least, has been the experience of Swedish Medical Center in Issaquah, WA, in its quest to implement a more efficient, no-wait ED concept. The approach appears to be sitting well with patients, too.
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After Good Samaritan Hospital Medical Center in West Islip, NY, began a comprehensive process to reduce readmission rates for heart failure patients, readmission rates dropped from 21.1% to 15.3% in just a few months.
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Every case manager encounters challenging patients and family members those who are angry, provocative, depressed, or just plain ornery. That's because people in the hospital are sick, under stress, and often fearful about their situation.
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A far-reaching redesign of the care coordination process at Norfolk, VA-based Sentara Healthcare has standardized the process across hospitals, centralized the administrative and clerical tasks that care coordinators must perform, and freed the staff at the bedside to concentrate on working with patients.
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A pilot program at MetroHealth Medical Center in Cleveland resulted in significant drops in emergency department visits among Medicaid recipients who were "ultra-users" of emergency care and participated in the one-year study.
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For years, the Centers for Medicare & Medicaid Services (CMS) state operations manual has had guidelines for surveyors to assess issues related to patient safety at hospitals. But there is such a wide range in size and scope of hospitals, says Marilyn Dahl, CMS director of the division of acute care services, that the organization decided it would be a good idea to create some sort of prompt for surveyors to use.
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To prevent readmissions when patients are transitioning from the acute care hospital to an inpatient rehabilitation center, case managers should make sure the patients are appropriate for acute rehab, that their medical conditions are stable, and that they can tolerate three hours of physical therapy every day.
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As we discussed last month, healthcare reform has changed the landscape of healthcare and of case management. Emerging trends and changes related to reimbursement, readmissions, pay for performance, outcomes and newly contracted reviewer agencies such as the Recovery Audit Contractors (RACs), have changed familiar payment methods and audits to new and different ones in a short amount of time.
