October 29, 1998

At our October 27 Communications Meeting, an outstanding presentation was given concerning the work of the Department of Outcomes Management, Research and Development. The services provided, as outlined below, are aimed at one of our primary goals...to improve the value of our service (i.e., ensuring high quality, cost effective care). The work of this department is a concrete example of how clinical services can be improved through interdisciplinary efforts and data analysis.

On another note, we are continuing our efforts to focus on cost control by closely monitoring staffing throughout the Medical Center. As a starting point, all PEAR forms for new hires are to be sent to the respective administrator with appropriate justification for the need to fill the position(s). Also, Medical Center Financial Services staff are in the process of benchmarking our staffing levels with other high performing organizations to determine potential opportunities for cost control. Our intent is to align our staffing levels with comparable high performing organizations and to control costs without adversely affecting current employees.

W. Stuart Smith, Interim Vice President for Clinical Operations Interim CEO, MUSC Medical Center

Announcements

• Ambulatory Care Clinics will be open for normal working hours Wednesday, Nov. 11 (Veteran’s Day).

Department of Outcomes Management, Research & Development

• At the Oct. 27 communications meeting Cameron Evers, MSN, continuum of care manager, Adult Services, Cherlyn Monroe, MSW, social worker, Adult Services, and Sharon DeGrace, MSN, outcomes manager, Adult Services, presented to the management team an overview of the wide range of services provided by the Medical Center’s Department of Outcomes Management, Research and Development. The department’s responsibilities include social work services, the outcomes management program and the continuum of care program as described below.
• The department director position is currently vacant and recruitment efforts are underway. The department’s co-interim directors are Karen Weaver, R.N., M.A., clinical director, Surgery, Women’s & Infants’ Services, who has responsibility for the outcomes managers, and Marilyn Schaffner, MSN, CGRN, clinical director, Digestive Disease Center, Medicine & Oncology, who has responsibility for social workers and continuum of care managers. Katrina Nell, MHA, is the department’s operations manager.

Social Worker Requirements and Organization

• Our social workers must have an MSW degree q Social work services have been available since 1969 and since that time the organizational reporting structure for social services has changed a number of times.
• In 1996, social workers within the main hospital became part of the Department of Outcomes Management, Research and Development.
• There are 14 social workers and work assignments/case loads are unit based.
• The social worker’s focus is upon social and financial needs.

Social Work Scope of Care

• Available to all patients and families who need services
• Provided routinely between the hours of 8:30 a.m. - 5 p.m. (Mon. - Fri.)
• Social workers are on-call for emergencies and complex patient care issues during evening hours and weekends

Social Work Services Provided Include:

• Coordination of care for patients and caregivers with biopsychosocial needs that impinge upon:
• diagnosis
• treatment
• hospitalization
• recovery
• discharge
• transition between care environments
• training of social workers and other health care providers

Social Work Services Mandated by Various Regulations include:

• Patients seeking organ transplantation
• Patients who are victims of abuse or neglect
• Patients who are victims of domestic violence
• Patients who are substance abusers

Candidates for Social Work Services

• Upon a patient’s entry into the hospital, a complete nursing assessment is done and if certain risk factors are detected then proper documentation is made and Social Work Services is contacted.
• Examples of issues which trigger the need for social services include:
• problems in coping with and adapting to illness at all stages
• emotional/behavioral responses to care
• impaired functional levels as a result of drug and/or alcohol abuse
• limited support systems
• a need for on-going post-hospital placement (e.g., rehab, psychiatric, long-term, subacute, foster care, residential placement and adoptions)
• problems with transportation
• no income or medical insurance coverage
• issues associated with non-compliance
• limited accessibility to care
• other legal issues (guardianship, etc.)
• conflict with the care team regarding treatment
• ethical dilemmas as a result of patient care decisions
• lack of housing (homeless)

Social Work Interventions Include, but are not limited to:

• Comprehensive assessments
• Information and referral (utilization of community and MUSC resources)
• Advocacy and empowerment
• Education
• Consultation and collaboration
• Counseling (supportive, financial, crisis intervention)
• Provision of concrete services (assistance in obtaining D/C meds, transportation, meals, DME, lodging)
• Social work documentation (outcome) database, MD progress notes, PT education sheet (as indicated)

Social Workers Participate in a Variety of Interdisciplinary Activities Including:

• Hospitalwide Committees and Task Forces
• Discharge Disposition
• Heart Transplant Patient Selection Committee
• Hospital Performance Improvement Team for the Implementation of Admission and Discharge Processes for Adults
• Hospital Grievance Committee
• JCAHO Patient Focused Team
• Multicultural Task Force
• Palliative Care Process Improvement: Improving End of Life Care
• Placement Barriers
• Performance and Outcomes Measurement Systems

Teaching

• Graduate and undergraduate social work students
• Students of other health care professions
• Medical students (co-facilitators of ICM courses)
• Mentorship of high school students

Community Involvement

• Participation in forums, health fairs, career days (elementary and high schools)

Continuum of Care Managers

• In 1988, the “case management” model was implemented at the recommendation of the Ernst & Young consultants. At that time, they were called “ case managers.”
• In 1996, the “outcomes management model” was implemented which resulted in the creation of population based outcomes managers (who focus upon data) and continuum of care managers (who have a clinical focus). There are 16 continuum of care managers and eight outcomes managers.

Continuum of Care Managers’ Primary Roles Are: Coordinate interdisciplinary treatment plan for complex patients across the continuum of health to enhance quality

• interface with all levels of medical & nursing staff, pharmacy, PT, OT, radiology as well as primary care providers and community resources
• facilitate the development and revision of interdisciplinary clinical pathways to improve quality and manage resources
• coordinate information regarding reimbursement
• resolves benefits questions with payors

Clinical expert for health care team

• master’s prepared resource for patients, families, other disciplines, students, administrators

Education

• provide nursing staff/student inservice as requested; role model effective patient management strategies
• educate community agencies regarding MUSC services
• present research, case studies, poster presentations at local, regional and national conferences

Leadership

• represent populations on various IDT’s, committees and task forces

Requirements

• master’s degree in clinical specialty

Outcomes Managers’ Primary Roles

Collaborate across disciplines and services to achieve desired functional, clinical and cost outcomes

• identify high volume, high risk and high resource consuming populations
• facilitate data analysis and PI initiatives to implement changes in systems and practice
• provide appropriate benchmark sources

Requirements

• master’s degree in clinical specialty

Examples of Outcomes Manager Productivity

• In 1997 and 1998, hospitalwide data collection regarding patient discharge issues
• Readmission tracking system development
• presented to the State Budget and Control Board, office of Research and Statistics
• Hospital Patient ID Band task force member
• Hospital Information Systems Selection committee
• Oacis representative for Children’s Hospital
• MUSC coordinator of UHC pneumonia project
• Co-chair pancreatitis interdisciplinary workgroup
• Neonatology value enhancement project
• Palliative care team membership
• Hospitalwide discharge PI team member

Who Do You Call?

• Call 792-0076 for names, pagers and telephone extensions
• Social worker for patient social, financial and transportation issues
• Continuum of care manager for patient issues that require clinical expertise
• Outcomes manager for patient population and systems information