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Case management strategies to manage long length of stay

HCPRO Website, January 26, 2016

Patients with a long length of stay (LOS) can be a challenge for case managers. The goal of case managers is to ensure that care for these patients is efficient and smooth, but sometimes there are some pretty big barriers in the way of a smooth discharge to the next level of care.

There are many reasons why a discharge may be delayed, including the severity of the patient’s condition, the challenges of securing a postacute bed, or indecision on the part of the patient about the facility to select for the next level of care.

One tool that can help aid in a smooth discharge is the use of weekly LOS rounds. These rounds are specifically designed to focus attention on long LOS patients and to help work past those challenges. In the book Core Skills for Hospital Case Managers: A Training Toolkit for Effective Outcomes, authors Toni Cesta, PhD, RN, FAAN, and Beverly Cunningham, MS, RN, talk about the advantages of using these rounds in successfully managing long LOS patients.

These rounds run in addition to traditional interdisciplinary team rounds and are designed to follow up more closely with long LOS patients. Team members for the LOS rounds should include the following:

• Case management leaders
• The patient’s case manager
• The team social worker

The team should take time weekly to discuss patients, focusing on the following:

• What progress has been made toward patient goals
• What specific issues are extending the LOS
• Strategies or interventions the team might want to try in the future

These weekly LOS rounds are just one of many interventions that case managers can use to help get the discharge process for long LOS patients back on track and moving forward.

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