Posts tagged ‘Care Coordination’

Jan 12

Case Conferencing

When it comes to good patient care there is no substitute for case conferencing. In my years of experience, I have seen agencies who chose not to conduct a structured case conference, agencies who held a meeting where patients were discussed just long enough to meet minimum standards and I have seen agencies that make the absolute most out of a weekly or bi-monthly case conference. Guess which agencies do better overall?

With OASIS-C now a reality, there are even more reasons to conduct a thorough case conference that includes process measures. In doing so, discharge reviews will be much easier to perform.

These are some of the processes I’ve seen at various agencies over the years that make case conferencing more effective. Pick and choose those ones that you like and send us any other ideas we might not have heard.

Prepare a list of patients up for recert in advance so that charts can be reviewed by the RN who will do the recertification visit.
Invite all disciplines involved in care. I have seen some agencies where aides are not included. This is a critical mistake.
Ensure that all the questions you want answered in case conference are addressed. You may want to make a short form or post the questions in the agency. That way the nurse who is reviewing the clinical record prior to case conference is aware of the information that she will be asked. Consider the following questions:
1. Has the patient seen the doctor this episode and if so, why?
2. Was any lab drawn? What are the abnormal results?
3. Were there any medication changes?
4. Was the patient taught on all medications?
5. Did the patient go to the hospital at all? Why?
6. Does the patient have heart failure? If so, what are the weight ranges?
7. Does the patient have diabetes? What are the blood sugar ranges?
8. Did any falls, injuries or other adverse events occur during the episode?
9. Did the patient have a wound? Describe at beginning and end of episode. State wound care and any changes that occurred in the last episode.
10. How was the patient’s pain managed? Were any interventions implemented with or without success?
If a staff member is not able to attend, try to include them on the telephone.
Get signatures of all attendees.

Or you could just pull the staff in from the field, feed them donuts and do the bare minimum to demonstrate compliance to the care coordination condition of participation. Either way, it costs whenever you bring field staff in for mandatory meetings. Why not get the most for your dollar?

Nov 15

2 Comments

But Did You Call the Doctor?

Care Coordination is one of the most frequently cited deficiencies in state surveys. We seem to know the docs who don’t care about blood sugars out of parameters or won’t give wound care orders so we just don’t call them. Now, in addition to state surveys, the OASIS-C dataset will be looking at our communication with physicians.

Several questions in the OASIS-C dataset ask if the MD was notified in one calendar day. What the question really means is, “Did you notify the doc within one calendar day and get a response?” A fax confirmation is not a response for the purposes of this question!

And sometimes, the answer will be, ‘No’. No matter how hard you try or what action you take, sometimes, the physician or their designee will not be responsive. Consider a late Friday afternoon admission where a review of medications reveals that the patient is on both Zantac and Tagamet – a potential duplication of medications. You notify the MD after your admission and for some reason he doesn’t get back to you until Monday morning.

Many times, on call physicians leave all non-urgent calls for the patient’s regular physician. Some docs trust you to hold one of the meds until you hear back from them. Some docs are lazy and slow. And some, a very small minority, may not care.

So, what do you do? The way that these questions are phrased begs the ‘correct’ response of, ‘Yes’. And the same agencies that deliberately skew outcomes will undoubtedly have perfect scores on these questions. My clients will not. They have been taught to do their best and to answer according the events that take place in reality – not on Planet Julianne where every doc is doing nothing but sitting by the phone eagerly awaiting our phone calls.

And if anyone tells you to differently, remember that the OASIS-C dataset is a legal document with your signature on it. Take the time between now and the first of the year to educate referral sources. Since MD’s are also subject to outcomes, most will understand why you suddenly become so needy after the first of the year.

And if you look not so hot on paper, remember your choices are to be less than honest or devote an enormous amount of time to satisfying a dataset. In other words, look at your patient and do what needs to be done to take care of them and document appropriately. The last thing we need five years down the line is useless data because not everyone is answering the questions in the same way.

OASIS-C education is ongoing at our office and we would love to visit you onsite. If you are in need of staff training, please do not hesitate to call 225-216-1241 or email haydelconsulting@haydelconsulting.com.