BY JOSE ALEJANDRO, PhD, RN-BC, MBA, CCM, FACHE, FAAN
In this issue of CMSA Today, we explore blood and bleeding disorders and their impact on case management professional practice. The American Society of Hematology (2019) notes that “millions of Americans are affected by blood disorders each year” and that these blood disorders include clotting and bleeding disorders, anemia, sickle cell disease and blood cancers. The 2016 emergency department statistics from the Centers for Disease Control and Prevention indicate that there were more than 695,000 emergency department visits for diseases of the blood (Rui, Kang & Ashman, 2016). Many of these visits were associated with “super users,” patients who had more than six emergency department visits in a year (Simpson, et al., 2017).
Case management professionals are key stakeholders who should be included on the inter-disciplinary care team in the emergency department setting and other healthcare entry points. There is a significant opportunity to improve the effectiveness and efficiency of emergency department services by addressing the complex health and social needs of individuals at the point of entry. Several organizations have demonstrated the effectiveness of early intervention to address social determinants that limit access to care in more appropriate settings.
For example, many working parents find it difficult to access healthcare services during normal working or school hours. When there is a lack of availability of outpatient services during non-working hours, the emergency department becomes the most logical point of care for these working parents. This is a great opportunity for case management leaders to collaborate with community stakeholders to improve off-hour access to care.
Reviewing “super user” demographics and diagnoses is another important strategy. Determining what vulnerable populations are seeking care in the emergency department is an important way of prioritizing initiatives to reduce frequent visits that can be resolved in a more appropriate setting. Each community will be different regarding priorities and potential interventions that ultimately improve access to appropriate care.
There is a clear connection between emergency department use and vulnerable populations. Many organizations are seeing increasing visits by the homeless, dialysis, undocumented and sickle cell individuals. Case management intervention within the emergency department is critical in these situations. Again, developing community partnerships and developing collaborative network relationships is key in assisting individuals with complex needs transition to alternative healthcare delivery points.
In addition, case management professionals in the emergency department can assist organizations to comply with increasing regulations specific to developing safe discharge plans. Many states are enacting regulations that require significant documentation regarding homeless population interventions. These new requirements necessitate additional case management resources within point of entry access points.
I hope you find this edition of CMSA Today helpful when considering how you can enhance case management practice within your organization.
American Society of Hematology. (2019). Advocacy. Retrieved from: https://www.hematology.org/Advocacy/.
Rui, Kang & Ashman. (2016). National hospital ambulatory medical care survey: 2016 emergency department summary tables. Available from: https://www.cdc.gov/nchs/data/ahed/nhamcs_emergency/2016_ed_web_tables.pdf.
Simpson, G. G., Hahn, H. R., Powel, A. A., Leverence, R. R., Morris, L. A., Thompson, L. G., … Allen, B. R. (2017). A Patient-Centered Emergency Department Management Strategy for Sickle-Cell Disease Super-Utilizers. The western journal of emergency medicine, 18(3), 335 – 339. doi:10.5811/westjem.2016.11.32273
Jose Alejandro, PhD, RN-BC, MBA, CCM, FACHE, FAAN
Dr. Alejandro is the Director of Case Management at UC Irvine Health, Orange County’s only Level 1 Trauma and Burn Center.
IMAGE CREDIT: KLENGER/SHUTTERSTOCK.COM
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