DorlandHealth

Toni G. Cesta, Ph.D., RN, FAAN, is the corporate vice president, Patient Flow Optimization for the North Shore, Long Island Jewish Health System in Great Neck, N.Y., and a health care consultant and partner in Case Management Concepts LLC.

Q: You have long been a leader in addressing efficiency of patient flow. Can you describe patient flow and tell us why it is important?

A: Patient flow is the management of all the patient care processes that support the patient as he or she transitions through the current episode of care. In the hospital setting, patient flow is considered one of the strategic activities used to manage length of stay and cost of care. For the case manager, it incorporates the activities of coordination and facilitation of care. The goals of patient flow/coordination and facilitation of care include:
• That the plan of care is expedited and barriers to efficient through-put are identified and corrected.
• That the patient is provided care in a timely manner.
• That the patient moves smoothly through the acute continuum of care.
• That each hospital day is optimized

The key functions applied to the role of patient flow/coordination and facilitation of care might include the following:
• Lead and/or attend daily interdisciplinary patient care rounds.
• Create a plan of care which outlines the key interventions and outcomes to be achieved each day of the in-patient stay.
• Coordinate the key interventions among and between the members of the interdisciplinary care team.
• Identify delays in patient care processes and intervene to correct them

The management of patient flow is the principle and most important role that the hospital case manager performs. All other roles stem from this first role.

How can case managers prepare for the expansion of IT so they can be a catalyst for innovation?

Most organizations are implementing electronic medical records (EMR). During the selection and implementation phase, while the hospital is selecting and designing the EMR, case mangers must be involved in the teams designing their hospital’s EMR.

It may be necessary for the hospital to have a supplemental software program that is specific to case management and that can be interfaced with the hospital’s EMR. This is no different than a specialized radiology or laboratory software program. Case managers must be aware of the latest case management software applications and work to ensure that their organizations consider case management’s software needs.

What do you predict to be the biggest challenge professionals involved in the practice of case management will see in the next five to 10 years?

Case managers will continue to struggle with two principle issues. The first is appropriate staffing ratios. The second is data collection and analysis. Managing data and relating case management outcomes to data will be the most important way in which to demonstrate case management’s impact on the hospital’s cost and quality outcomes.

This data, if reported correctly, can be used to justify appropriate staffing ratios. Those of us in leadership positions need to continue to communicate adequate staffing ratios to non-case management leadership in our organizations.