LOS and Case management

hillsandovals@email.chop.edu

Hello fellow CDI. My department has been looking to discuss our calculated APR-DRG , and SOI with the case managers in hopes of helping to make them aware of the expected the length of stay with some patients. I was wondering if any of you address this information with your case management dept, and if so have you gotten any kick back from them.

For example: I am worried if a child's expected LOS is 10 days and the case manager waits until day 8/9 to prepare for d/c, but the child has been medically cleared on day 4/5, how does one deal with this situation. As many of us know that d/c planning starts on day of admission, but in reality, many wait until the 11th hour.

Thanks,

Steph

jackietouch@aol.com

Very good points, Steph. Our program is nearing it's 2 year birthday and most of our case managers are not aware of what we do (we report to HIM-different department). We have been trying to educate our case managers based on impact on LOS just as you have described. Our current software does not have LOS visible to our case management team, so it has been challenging. 

On cases like the one you have described, I try to review the chart daily (for exceeded LOS, physician documentation of medical clearance, documentation of avoidable days by the UM director, etc) and if I am able to impact SOI and LOS I inform the case manager who then works to adjust avoidable days with the UM director if appropriate. These conversations are easiest face-to-face, especially if the case manager is covering or not familiar with the case. The case managers rarely notify CDI of cases that have exceeded LOS (cases that we are not following) so I am sure we are missing opportunities with those cases.

We are working on enhancing the relationship between CDS and case management and hopefully this will make this process more seamless.

Hope this helps and hope you have great holidays!!
Jackie Touch
CHOC Children's, Orange, CA 

gspatafore

Our department started working with Case Management over the past year on LOS. We report to multidisciplinary rounds to discuss LOS and it is posted in AllScripts and Cerner for Case Management and providers to view. We initially had push back in that Case Management thought we were "policing" them. Now there is much better collaboration after some growing pains. We also have a daily exceeds LOS report that case management and director of the hospitalist program receive.