Converting case managers from MD/service to unit-based assignments: a before and after comparison.

Area of Science:

• Healthcare Administration
• Case Management
• Hospital Operations

Background:

• Acute care case management faces a persistent dilemma regarding optimal assignment structures.
• Both unit-based and physician/service-based models present distinct logistical and political challenges.
• Organizational decisions often hinge on balancing competing priorities and resource allocation.

Purpose of the Study:

• To describe a hospital's strategic decision and implementation process for transitioning case manager assignments.
• To evaluate the impact of shifting from a physician/service-based model to a unit-based assignment structure.
• To analyze the benefits and outcomes associated with a unit-based case management approach.

Main Methods:

• The study details a hospital's conversion from physician/service-aligned case managers to a unit-based assignment model.
• Qualitative description of the rationale and implementation process is provided.
• Quantitative outcomes related to time efficiency, care planning, patient volume, and care level management are presented.

Main Results:

• Unit-based assignment saved an average of 90 minutes per day per case manager.
• Care managers enhanced nursing's ability to plan, pace, and trace patient care.
• The hospital successfully managed a 9% increase in admissions and 140 additional referrals to the Transitional Care Unit.
• Consistent management of the observation level of care was achieved.

Conclusions:

• Transitioning to a unit-based case management model yields significant operational efficiencies.
• This structure enhances care coordination between case managers, nursing, and physicians.
• The unit-based model effectively supports increased patient volumes and ensures consistent care management.