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No matter how many drills your facility conducts, or how comprehensive your disaster plan is, real crises virtually always present unique challenges to those charged with responding to them.
For case managers, that may mean temporarily having to perform functions that aren’t traditional case manager responsibilities, says Beverly Cunningham, RN, MS, president of Case Management Consultants, in Toledo, OH, and a former case management director. It also means establishing and maintaining good communication with payers as well as counterparts in other levels of care so that you can help to coordinate a flexible response in unusual circumstances.
"Coordination of care is really important for case managers," she says. "Because if you’re going to be inundated with patients, you’ve got to be able to plan where is the best site for this patient to be taken care of?’ We know that when you have more patients in the hospital than you can handle that everyone can’t be in the acute care setting."
Cunningham stresses that the key to effective coordination of care is communication. "One of the biggest challenges case managers have is that we all get so caught up in our episode of acute care that we don’t talk to other levels of care, whether it’s rehab or home care, and even those that are in our own continuum." It’s also crucial to have an effective system of discharge planning in place before a disaster occurs. "If you don’t have good communication with your families already, if you haven’t done your discharge planning ahead of time, and you wait until the last minute to do it, you’re not going to be able to do it very effectively," she says.
At Vanderbilt University Medical Center, a Level 1 trauma center in Nashville, TN, the standard for discharge planning is for all patients to be screened and a plan developed within 24 hours of admission, says Evelyn Koenig, director of case management. "If it looks like the patient isn’t going to be able to easily return home and may need nursing home or rehab or something like that, referrals are begun early on," she says. So in the event of a disaster situation, "with the majority of patients, it would be very easy to look at the record, know what the discharge plan was, and begin to facilitate finalizing that, if that’s possible based on the patient’s condition."
Vanderbilt also maintains relationships with other local hospitals as well as with some nursing homes and rehabilitation agencies. Because Vanderbilt is the only Level 1 trauma center in the area, it typically gets a different type of casualty than other facilities. "So even with patients who cannot be discharged to the community, we have agreements whereby they can be discharged or transferred to other hospitals to free our beds for the trauma victims that only we can handle," Koenig says.
When a mass disaster is called at Vanderbilt, it’s case management’s responsibility to open the discharge center. Case managers immediately assess the availability of beds for potential victims, determine which current patients who could be discharged right away, and facilitate discharges, if necessary, by sending those patients to the discharge center. At the discharge center, teams of social workers and nurse case managers process patients either to another level of care or the home, as appropriate. If normal means of transportation are disabled, the medical center would have access to Vanderbilt University buses.
In addition to their other responsibilities, social workers have primary responsibility to provide support to family members whose loved ones have been injured, or who come to the hospital looking for someone. "A visitor center is opened that’s actually run by our patient affairs department, but social work has primary responsibility to assist with counseling, comfort, grief, matching victims to family members, and that kind of thing," Koenig says. n
The unimaginable has happened in New York City. At Saint Vincents Hospital, less than three miles from the site of the World Trade Center attack, the disaster plan was put to the test as dedicated professionals rose to the unique challenge of responding to the attack. American Health Consultants, publisher of Hospital Case Management, invites you to learn from the firsthand experience of the professionals at Saint Vincents how to take a new look at your disaster plans so that you will be ready if the unimaginable happens in your community:
Each participant will have the opportunity to earn 1.5 free AMA Category 1 CME credits or approximately 2 free nursing contact hours. For details, visit www.ahcpub.com, or call (800) 688-2421 to register today!