House Staff Manual - Winthrop University Hospital

At Winthrop, Case Managers initiate review of medical records of all patients within 1 working day ofadmission and continue until discharge using established written criteria. If these criteria are not met, thecase is referred to a Physician Advisor who discusses the case with the attending physician. Issues relatingto length of stay are critical. In order to assist the utilization staff in making appropriate and timelydecisions, House Staff is requested to:Write comprehensive progress notes with specific documentation describing the patient's condition,symptoms, management and treatment plans.Refer patients with potential discharge problems immediately, even before admission if possible, to theCase Management Department.Diagnostic studies, procedures and consultations must be ordered and completed in a timely manner;extra hospital days are costly.Telephone for test results, etc., and record same in progress notes. This will prevent unnecessarydelays, which could result in extra hospital days.Always include documentation, which clearly reflects the patient's continued acute status. "Stable","Doing Well", unaccompanied by documentation of acute conditions, will result in an insurancereimbursement denial, as the documentation implies that the patient is ready for discharge.Record the medical reasons for any pre-op day. Avoid unnecessary pre-op days, which will result incostly extra hospital days.Avoid discharge delays. Patient must be discharged immediately when medically ready for discharge.Extra days generate reimbursement denials and are costly.When Medicare or Medicaid patients are medically ready for discharge, and have a skilled nursingneed but cannot leave the hospital because they are awaiting post-acute care facility placement, or needHomecare services, the progress note must state that "patient at alternate level of care (ALC)," andstate the level of care and/or facility to which the patient will be discharged.Whenever possible, give a patient 24 hours notice of impending discharge.Please make every effort to write legibly. Errors and conflicts are often due to the fact that notescannot be read.For more information on the Utilization Management process, contact the Department at ext. 2732.CLINICAL SUPPORT SERVICES83. DISCHARGE PLANNING SERVICESThe Case Management Department provides for continuity of care to all patients, as needed, to the home,rehabilitation or skilled nursing setting. All discharge plans are developed and implemented in consultationwith the patient, family and physician.The Case Managers who perform discharge planning screen all patient admissions via established screeningcriteria, assess patients’ meeting of these criteria, assist patients and family with insurance information anddevelop appropriate discharge plans.Team conferences for patients with complex discharge needs are held as needed where patients arereviewed, discharge-planning options discussed, and plans initiated.Rev. 1/08