ROANOKE TIMES
Copyright (c) 1996, Roanoke Times
DATE: Sunday, April 28, 1996 TAG: 9604300029
SECTION: NURSES PAGE: 9 EDITION: METRO
SOURCE: SARAH COX
Kereen Mullenbach, vice-president of patient care services at Lewis-Gale Hospital, described the hospital's newly organized case management system as ``a process designed to make sure the patient gets the right treatment at the right time in the right way."
From pre-admission to post-discharge, she said, this approach is designed to help patients achieve better overall health through a careful follow-through of a multi-disciplinary team. Pathways in specific medical areas have been developed since the pilot program began in October 1995.
Now there are pathways for total hip replacements, open heart surgical procedures, angioplasties, radical prostatectomy and carotid endarterectomy. Mullenbach said the hospital's goal is to have 15 pathways in place by year's end.
Mullenbach said they've been accused of only reducing costs with this case-management approach, but that's just one aspect and not the primary goal, she said.
To effectively utilize their resources, Mullenbach said, they examine the entire patient's history, set out a plan and follow the patient through to the end. Mullenbach described case management as continuum of care, with nurses being responsible for coordinating and implementing that care. Of course, she said, nursing has always been about that anyway.
Before this approach, sometimes a patient's needs exceeded the number of people to take care of them. Case management makes organizing care easier: Nurses are the assessors, planners, implementors and evaluators.
With an orthopedic patient in for a total hip replacement, the patient would be visited in his home prior to admission. An assesment would be made concerning ``how we can assist in the home," said Mullenbach. The patient would be given pre-admission exercises to do prior to the hip replacement, and a film on exercise training.
In the hospital, everyone - the physical therapist, home health nurse, rehabilitation personnel, etc. - would be aware of the patient's plan and guidelines.
This case-management approach, said Mullenbach, reduces repetition, streamlines care and makes it more effective.
In another case scenario, this time with a patient who has chronic obstructive lung disease, Mullenbach said they would ``access other information, and look at how the patient did with past problems so we would not keep repeating ourselves through what didn't work."
The case coordinators are nurses who are given incentives with rankings one through three to be promoted. The highest would be a nurse with a masters degree and a background in a clinical specialty.
``As you move up, the more involved you are in developing the pathway and heading up the pathway," said Mullenbach. The nurses, she said, are readily responding to this new system because ``everybody wants to do what's best for the patient. An R.N. cannot work alone - she needs others' help.
"Having someone you know is a liaison with the team has got to relieve people's frustrations,'` Mullenbach said.
Mary Beth Hunziker, a clinical nurse specialist, helped develop two of the pathways at Lewis-Gale Hospital. She said at this time, the whole plan of care is mapped out for a multi-disciplinary team, and takes into consideration everyone who is needed to help the patient.
``It helps ensure that nothing falls through the cracks," said Hunziker. She said it is working, it is making patient care more efficient, and a big piece of health care - patient education - is becoming more and more integrated into the case-management picture.
``By expending more energies, meeting patients' needs better, and so reducing patient costs in the end, they get better quicker and stay better,'` she said.
Hunziker said they're teaching pre-admission classes for patients, teaching them how to move after surgery and giving them exercises before surgery to help them do so, and looking closer at home health agencies. They're also improving communication between the hospital and the home health agencies.
She explained that because these pathways are still ``in their infant stages," there will be more changes, and nurses will become increasingly involved and ``proud of their responsibility."
LENGTH: Medium: 77 linesby CNB