LOS and case management
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
Comments
Our case management department has weekly meetings and LOS is discussed I believe (CDI is no longer involved in these meetings as when I 1st started CDI several years ago... not sure why).
Funny that you posted this today because yesterday my boss discussed with me that she will be creating a small committee with CDI (me), Peds case managers, and a few select hospitalists to discuss LOS, any CDI issues, and other things.
Claudine
I agree Jeff.... that is one of our main factors impacting high LOS (DHS/social/custody issues). Plus sometimes a child with several diagnoses isn't discharged due to fear of lack of follow-up so we keep them until they recover from the acute illness and then do surgery for another chronic problem.
Hi Jeff and Claudine, thanks so much for the feedback. I am thinking of possibly starting a small committee to start off to see how this can be rolled out.
Thanks, Steph
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
Seems that we are not alone in our challenges in the peds CDI world. Great ideas for increased collaboration with other departments!!
I guess as a past case manager, I can predict a little push back from them with a response of , "so what do you want me to do with this information. If the child is not ready to go, then it is the docs fault, not mine."
Thoughts?
steph
Hi Chutchinson, I was wondering if you would not mind sharing your feedback on how the case managers deal with the LOS issues. Also, if and when you begin you task force meetings , would you mind sharing a little as well.
Thanks so much
Steph