Discharge Planning adopts team approach for improved coverage

The Discharge Planning Unit has moved to the Department of Clinical Social Services and adopted a new approach aimed at providing more consistency in coverage for patient areas through the use of interdisciplinary teams of discharge staff.

Discharge Planning formerly had been paired with Utilization Review in the Patient Services Department, which will remain within that department. Under the previous arrangement, nurses handled both utilization review and discharge planning duties. With the reorganization of the two units, separate staffs now handle their services.

As part of Discharge Planning’s move to Clinical Social Services, its clinical case managers will be an interdisciplinary group of health professionals consisting of nurses and social workers. This approach is expected to be especially beneficial in the discharge of patients with complex psychosocial issues.

Discharge Planning has 4.5 vacant, FTE clinical case manager positions. More information on the positions is on the UC Davis Health System Web site.

The primary responsibilities of clinical case managers involve coordination of services that provide safe, timely discharges. Discharge planning services include referrals to home health agencies, hospice and/or skilled nursing facilities. Other services include the arrangement of specialized equipment required by certain patients for safe discharge, such as those for intravenous infusion and total parenteral nutrition. Case managers also provide assistance when patients do not have appropriate legal representatives for medical decisions. Consultation and assistance are provided for patients needing conservatorship and other court authorizations.

A major goal of Discharge Planning is more consistent coverage of patient areas with the use of three teams composed of interdisciplinary staff. Each clinical case manager will have a primary assignment. In the absence of any given staff members, another member of the same team will provide coverage. This model will promote familiarity with patient needs, the staff within a team and assigned units.

Each team will be assigned a discharge planning assistant, who will coordinate home-health referrals, placements, durable medical equipment referrals and other discharge planning service needs.

The clinical case manager teams and their primary assignments are below:

Team One Case Managers

Lea Ann Mason D7, T7 and E7 (PICU’s)

Joanne Testerman T3, D3, D5

Barbara Cote E5, T5-NSICU

Judi Rogers T8, T6-MICU

One vacant .5 FTE to fill

One vacant FTE to fill

One discharge planning assistant

Team Two Case Managers

Alison Peters D14, T2-SICU I

Debbie Folsom E4, T5-Burn Unit

Susan Garland TNU, ER (consultation)

Victoria Hildebrand E6, SICU II

One vacant FTE to fill

One discharge planning assistant

Team Three Case Managers

Jeania Pardlow-Thomas T4, T7-MSICU

Leslie Brown D6, T6-CCU

Mary Margarita D8

Karen Maider D12

Two vacant FTE’s to fill

One discharge planning assistant

The PM&R/Acute Rehabilitation program will be obtaining its own case manager for discharge planning. Questions regarding discharge planning services for the PM&R program or the outpatient clinics should be directed to Patsy Bethards, LCSW, at pager number (916) 762-6l94.

The Clinical Case Manager teams would like to meet with the staff on the nursing units. They will be contacting nurse managers to set up a time in May to discuss these changes. The Clinical Case Management Unit for Discharge Planning is supervised by Bethards, who may be reached at (916) 734-5181 or by pager at (916) 762-6194. For Discharge Planning Service referrals, call (916) 734-7327 or (916) 734-2944.

Utilization Review is committed to the delivery of quality, cost-effective patient care and continuity of care through the coordination of internal and external health-care resources. Utilization review services are provided by a team of Patient Services and UC Davis Managed Care registered nurses assigned to areas throughout the hospital.

The utilization review nurse is an advocate for patients, overseeing the delivery of care. The nurse is responsible for the medical review of hospitalized patients to monitor for appropriate utilization of the hospital stay, ensuring reimbursement by obtaining authorization for services rendered, assisting in the coordination of applying for possible insurance coverage when there is none identified at the initial hospital registration, and collaborating with discharge planning clinical case managers and physician teams to assure timely coordination of services.

Appropriate utilization of hospital services is determined by:

• Review of the medical record
• Discussions with the physicians
• Collaboration with other members of the health care team

Standardization criteria are used (InterQual), supporting a consistent, evidence-based tool for decisions related to medical necessity. A physician reviewer also may be consulted for questions related to medical necessity or the plan of treatment.

The utilization review nurse also works collaboratively with the Admissions Office, financial counselors and eligibility workers to help uninsured patients apply for coverage under Medi-Cal, or through the patient’s county of residence’s Medically Indigent Program, or other potential sources of reimbursement for health-care services. The utilization review nurse is a resource for the patient and the health-care team in determining what resources are available for the patient’s continuing health-care needs.

Due to the increasing complexity of health care, each utilization review nurse has been assigned to a specialty or specialties. Those with specific utilization questions regarding Medicare, Medicare part D, Medi-Cal, prisoners, VA, CCS, Maternal Child, county case-managed patients, termination of benefits letters, insurance appeals, InterQual criteria, observation level of care and Medicare one-day stay reviews should contact the Patient Services Department at (916) 734-2944 for the utilization nurse assigned.

There is also a lead utilization review nurse position that will be rotated weekly to assist with problem solving.

The following utilization review nurses are assigned by nursing unit clusters and the number of nurses available daily (Monday through Friday):

Utilization Review Nurse

Robert Wright D12, D14, Clinics, ED, TISS

Lori Bergeman D6, E6, T6-CICU, T6- MICU

Letha Withrow D8, T8, Phoenix Respiratory Unit E8, T7-MSICU

Joy Thomas E5 Rehab, E-5 Neurosurgery, T5-NICU, T5-Burn, T2-SICU

Lori Sondheim TNU, E4, T4

Doretta Morgan D7, T7-PICU, E7-PICU, D5-ICN/CCN, T3, D3

These utilization review nurses are assigned as floats: Vickie Campbell, Pat Delmendo and Linette Carson.

Marian Keene, a UC Davis Managed Care utilization review nurse, is assigned to all in-house UC Davis managed-care patients.

The Transfer Center will coordinate with University Case Management to provide utilization review and weekend clinical updates to County Case Management and Corrections. If any discharge planning is needed on the weekend, contact the weekend Clinical Case Managers at (916) 734-2944, option 2 or option 3 to leave a message.

The Utilization Review Unit is under the supervision of Kori Pilkington, nurse manager, who may be reached at (916) 734-2287 or by pager at (916) 762-5417.