CMSA Today - Issue 5, 2017 - 12

ED CASE MANAGEMENT

INTEGRATED CASE
MANAGEMENT IN THE
EMERGENCY DEPARTMENT
A Q&A WITH AN RN CASE MANAGER AND A
SOCIAL WORKER CASE MANAGER
BY MARY MCLAUGHLIN-DAVIS, DNP, ACNS-BC, NEA-BC, CCM

N

urse and social work case
managers are an integral part
of the emergency department
(ED) team. Although the case
management functions have
changed over time, the basic goals are the
same. The case manager understands that
many patients continue to use the ED for
primary care, despite the Affordable Care Act
mandating insurance coverage and access to a
primary care provider. Many patients find the
ED the most convenient and accessible door
to the healthcare system. The challenge for
ED case managers is the balance between the
necessary throughput of ED patients versus the
time and research necessary to provide a safe
and reliable discharge plan for patients from
the ED to home or to another level of care.
The ED is the access point to the acute care
hospital, and every patient entering the ED has
a universal, federal right to ED care without
earmarking payment for this care (Powell,
Tahan, 2008). The case manager can triage
patients who are in the ED for chronic disease
treatment, primary care needs, almshouse
services, food, comfort, clothing, and shelter (Cohen, Cesta, 2001). The case manager
and social worker ensure the patient's rights
are met and the ED is in compliance with
the Federal Emergency Medical Treatment
& Labor Act (EMTALA) https://www.
cms.gov/Regulations-and-Guidance/
Legislation/EMTALA/index.html). The
12

CMSA TODAY

social worker case manager evaluates patients
with behavioral health disorders - a risk for
suicide as well as drug and alcohol abuse
disorders. The social worker case manager
is required as ED teams struggle with the
current national opioid epidemic.
The integrated case management model
is never more appropriate than it is in the
ED, as patients present with complex medical and behavioral health diagnoses. The
expert nurse or social worker case manager
recognizes that many of these patients are
treated in silos according to their complaints
or diagnoses, rather than using an integrated
care plan.
The case manager nurse and social worker
can demonstrate value to their healthcare
organization by establishing care plans,
goals and outcome measures for the
hospital or free-standing ED case management programs.
CMSA interviewed a case manager RN and
social worker from two community hospitals
in Ohio. The interview was prompted by a
discussion between case managers across
the country and across the continuum of
care about the role of case managers in the
emergency department. A health plan case
manager has an interest in the role of the case
manager in the emergency department. She
understands, from working with members
in her health plan, that many of them use
the emergency department for primary care

Issue 5 * 2017 * DIGITAL

despite discussions with the members about
this not being the best use of resources.
The health plan case manager provided
questions to CMSA for the informal interview of the ED social worker and case manager, in order to learn how each of them
manages the challenges that patients in the
ED present. The following is the discussion
between CMSA and the ED case manager
and social worker.
CMSA: What do you see as your role and
responsibilities as the ED case manager?
RN Case Manager: I see myself as the
patient advocate. I understand my role is to
try to divert patients with social problems
from getting a bed in the hospital, if a bed
is not required. However, I understand that
the doctors are concerned if we cannot
move patients quickly. You just cannot move
patients to a safe place quickly.
Social Worker Case Manager: That's
where I come in. I work closely with the nurse
case manager and the ED team; we recognize
some of our patients are determined to come
into the hospital because this is a place they
can get food, comfort, and shelter. Some of
these patients are also seeking drugs.
RN Case Manager: No one day is the
same. I might walk into a patient's room and
think I will spend a short time getting them
a bus ticket and I end up talking with the
physician and recommending home care and
a wheel chair.



Table of Contents for the Digital Edition of CMSA Today - Issue 5, 2017

President's Letter
Association News
Cmsa Corporate Partners
Integrated Case Management in the Emergency Department
Early Collaboration for Improved Patient and Family Outcomes: Moving Patients From Acute Care to Rehabilitation Following Catastrophic Injury
Navigating Excellence: Professional Case Management Driving Exceptional Results in Value-Based Care Models
Emergency Department Throughput Times: Examples of How Technology Can Reduce or Increase Them
Cmsa Individual Membership Application
Index of Advertisers
CMSA Today - Issue 5, 2017 - Intro
CMSA Today - Issue 5, 2017 - cover1
CMSA Today - Issue 5, 2017 - cover2
CMSA Today - Issue 5, 2017 - 3
CMSA Today - Issue 5, 2017 - 4
CMSA Today - Issue 5, 2017 - 5
CMSA Today - Issue 5, 2017 - President's Letter
CMSA Today - Issue 5, 2017 - 7
CMSA Today - Issue 5, 2017 - Association News
CMSA Today - Issue 5, 2017 - Cmsa Corporate Partners
CMSA Today - Issue 5, 2017 - 10
CMSA Today - Issue 5, 2017 - 11
CMSA Today - Issue 5, 2017 - Integrated Case Management in the Emergency Department
CMSA Today - Issue 5, 2017 - 13
CMSA Today - Issue 5, 2017 - 14
CMSA Today - Issue 5, 2017 - 15
CMSA Today - Issue 5, 2017 - Early Collaboration for Improved Patient and Family Outcomes: Moving Patients From Acute Care to Rehabilitation Following Catastrophic Injury
CMSA Today - Issue 5, 2017 - 17
CMSA Today - Issue 5, 2017 - 18
CMSA Today - Issue 5, 2017 - 19
CMSA Today - Issue 5, 2017 - Navigating Excellence: Professional Case Management Driving Exceptional Results in Value-Based Care Models
CMSA Today - Issue 5, 2017 - 21
CMSA Today - Issue 5, 2017 - 22
CMSA Today - Issue 5, 2017 - 23
CMSA Today - Issue 5, 2017 - Emergency Department Throughput Times: Examples of How Technology Can Reduce or Increase Them
CMSA Today - Issue 5, 2017 - 25
CMSA Today - Issue 5, 2017 - 26
CMSA Today - Issue 5, 2017 - 27
CMSA Today - Issue 5, 2017 - Cmsa Individual Membership Application
CMSA Today - Issue 5, 2017 - 29
CMSA Today - Issue 5, 2017 - Index of Advertisers
CMSA Today - Issue 5, 2017 - cover3
CMSA Today - Issue 5, 2017 - cover4
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