| Learning Objective #1: Identify strategies to reduce inpatient stays for hospitalized children | |||
| Learning Objective #2: List key components of a case manager's role |
The purpose of this clinical project was to develop a Children’s Clinical Case Manager (CCCM) role at a large urban trauma center. Hospitals across the country are attempting to meet the challenges of reduced inpatient stays, the need to reduce resource use while continuing to improve patient outcomes. Case management is a strategy that can be implemented with complex, high-risk patients within the context of an interdisciplinary team to enhance quality of care and decrease costs across both inpatient and outpatient settings. In children, case management techniques have been used to optimize care for children with complex special health care needs, medically fragile infants and children, and children with other chronic illnesses. At this children’s trauma center, all the children’s care areas were judged as areas where there might be duplication of services, fragmented care, lack of follow-up, or ways to decrease length of hospital stay (LOS) for sick children. Use of the CCCM’s services has resulted in decreased LOS with some complex clients and increasing follow-up on discharged patients, both in the special care nursery and children’s units. As the CCCM has highlighted system failures, remedies have been implemented: in the business department with a dedicated children’s admissions clerk, and through the writing and funding of two grants, one to promote patient follow-up for discharged infants from the infant special care nursery and one in the children with special needs clinic. The children’s chief-of-staff, seeing the value of the CCCM, has obtained funding for a physician to promote follow-up with hospitalized children and their primary care providers. For nurses, children’s case management strategies can be adapted to improve patient outcomes and facilitate resource utilization in many hospital settings. Nurses are the coordinators of care and use both technical skills and political shrewdness to negotiate the complex hospital environment.
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