Case Management & Discharge

1. The case manger proactively evaluates patients at risk of readmission, or in need of post-acute referrals. A critical review of the following is taken into consideration: the medical history, medications taken, re hospitalizations consultant evaluations, test/procedure results, and input from the patient/family.

True

False

The given statement is true because the case manager actively assesses patients who are at risk of being readmitted to the hospital or require post-acute referrals. This assessment includes a thorough examination of the patient's medical history, medications, previous hospitalizations, consultant evaluations, test/procedure results, and input from the patient and their family. This proactive evaluation helps in identifying and addressing the needs of the patients, reducing the chances of readmission, and ensuring appropriate post-acute care.

Explanation

The given statement is true because the case manager actively assesses patients who are at risk of being readmitted to the hospital or require post-acute referrals. This assessment includes a thorough examination of the patient's medical history, medications, previous hospitalizations, consultant evaluations, test/procedure results, and input from the patient and their family. This proactive evaluation helps in identifying and addressing the needs of the patients, reducing the chances of readmission, and ensuring appropriate post-acute care.

2. An in depth case management assessment is basic to understanding the patient's previous and current response to treatment and how effective (or not ) the utilization of services are meeting the patient's needs.

True

False

An in-depth case management assessment is important because it helps healthcare professionals understand the patient's history and current response to treatment. This assessment also helps determine whether the services being provided are meeting the patient's needs effectively or not. Therefore, it is true that an in-depth case management assessment is basic to understanding the patient's previous and current response to treatment and how effective the utilization of services is in meeting the patient's needs.

Explanation

An in-depth case management assessment is important because it helps healthcare professionals understand the patient's history and current response to treatment. This assessment also helps determine whether the services being provided are meeting the patient's needs effectively or not. Therefore, it is true that an in-depth case management assessment is basic to understanding the patient's previous and current response to treatment and how effective the utilization of services is in meeting the patient's needs.

3. The case management assessment should be completed:

Within 24 hours to 48 hours.

As soon as convenient, just as long there is documentation in the chart.

Up to 72 hours.

Policy states that the case management assessment should be completed within 48 hours of admission.

Explanation

Policy states that the case management assessment should be completed within 48 hours of admission.

4. In the last 5 years, only 20% of the U.S, population used 80% of the total healthcare spending of $2.9 trillion dollars by some estimates. Forty-percent of hospitalized patients return within 30 days of discharge and cost Medicare an estimated $17.4 billion dollars An effective case management program aids in reducing readmission rates.

True

False

An effective case management program can help reduce readmission rates, which can in turn help decrease healthcare spending. If 40% of hospitalized patients return within 30 days of discharge, implementing a case management program that provides follow-up care and support can help address the underlying issues that lead to readmissions. By providing patients with the necessary resources and assistance, they may be less likely to require readmission, ultimately reducing healthcare costs. Therefore, the statement "An effective case management program aids in reducing readmission rates" is true.

Explanation

An effective case management program can help reduce readmission rates, which can in turn help decrease healthcare spending. If 40% of hospitalized patients return within 30 days of discharge, implementing a case management program that provides follow-up care and support can help address the underlying issues that lead to readmissions. By providing patients with the necessary resources and assistance, they may be less likely to require readmission, ultimately reducing healthcare costs. Therefore, the statement "An effective case management program aids in reducing readmission rates" is true.

5. The case manager looks for previous admissions and completes the readmission assessment only on patients that returned within 30 days to the same hospital.

True

False

Any acute readmission would trigger a possible problem in the previous discharge plan. Evaluating cause of the readmission can give insight on where the problem [of transition] lies.

Explanation

Any acute readmission would trigger a possible problem in the previous discharge plan. Evaluating cause of the readmission can give insight on where the problem [of transition] lies.

6. Case scenario: the case manager reviews a post-operative patient chart and finds that anti-coagulation is not ordered. Also, there is a completed PT evaluation, the OT evaluation was ordered but not seen in the chart. The patient has a commercial insurance product. What should he/she consider?

Leave a note on the chart for the physician to address the anti-coagulation requirement of SCHIP/post-op patients.

Page the OT on duty to find out when the evaluation will occur.

Wait for the PT therapist to tell the OT therapist.

Ask the hospital's Utilization Department to arrange for a skilled nursing facility precertification.

Timely and effective coordination of services is under the oversight of the case manger. He/she should address he anti -coagulation issue with the physician, and not rely on a note placed in the chart. the OT should be paged to address timely referral. The skilled nursing facility is responsible for obtaining the precertification, but the case manager ensures that the necessary referrals and information is forwarded to the patient's facility of choice.

Explanation

Timely and effective coordination of services is under the oversight of the case manger. He/she should address he anti -coagulation issue with the physician, and not rely on a note placed in the chart. the OT should be paged to address timely referral. The skilled nursing facility is responsible for obtaining the precertification, but the case manager ensures that the necessary referrals and information is forwarded to the patient's facility of choice.

7. Discharge rounds are essential to collaboration among the healthcare team and sharing of informatin of the patient's response to the treatment plan. It should include all of the following:

Physical, mental, behavioral status

Family gossip

The patient progressing/responding to treatment plan

Should reflect an interdisciplinary approach

Should never be documented, because it was a verbal interchange.

Discuss discharge readiness and appropriate level of care (ICU, SDU, RNF)

Discharge rounds are an important part of collaboration among the healthcare team and the sharing of information about the patient's response to the treatment plan. It is crucial that the discharge rounds include the patient's physical, mental, and behavioral status, as well as their progress and response to the treatment plan. These rounds should also reflect an interdisciplinary approach, involving various healthcare professionals. Additionally, it is important to discuss the patient's discharge readiness and determine the appropriate level of care they require, such as ICU, SDU, or RNF. Family gossip should not be included in the discharge rounds, and although the rounds are typically verbal, it is important to document the information discussed for future reference.

Explanation

Discharge rounds are an important part of collaboration among the healthcare team and the sharing of information about the patient's response to the treatment plan. It is crucial that the discharge rounds include the patient's physical, mental, and behavioral status, as well as their progress and response to the treatment plan. These rounds should also reflect an interdisciplinary approach, involving various healthcare professionals. Additionally, it is important to discuss the patient's discharge readiness and determine the appropriate level of care they require, such as ICU, SDU, or RNF. Family gossip should not be included in the discharge rounds, and although the rounds are typically verbal, it is important to document the information discussed for future reference.

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8. The discharge assessment usually indicates the expected level of care the patient will require upon discharge. This assessment should be done:

Simultaneously with the admission assessment.

Within 24 hours.

Within 24 hours and update throughout the hospital stay.

Only if there is a firm discharge plan identified.

The discharge assessment is current to the time it was made, and , should be updated throughout the hospital stay.

Explanation

The discharge assessment is current to the time it was made, and , should be updated throughout the hospital stay.

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