Case Management Services plays a vital role in creating the appropriate linkages with the health care team, insurance companies and community-based agencies to coordinate and implement a plan of care that is in the best interest of the patient, family and the Hospital.
The Case Management Team
Case Management services are provided by Case Managers who are Registered Nurses (RNs). On average, they manage between 15 to 25 patient caseloads, including those with complex medical needs. Case Management Liaisons provide support for our Case Managers, including follow-up with the family after discharge, and other various department functions.
Our Case Managers assess patients with complex medical discharge needs, such as patients who need home health nursing, special supplies and children with feeding tubes.
They anticipate discharge needs and collaborate with interdisciplinary teams to prepare the family for discharge. Case Managers also arrange in-home services, supplies, equipment and medications.
We evaluate patients on an ongoing basis to insure they are meeting criteria for admission and continued stay at Children’s as well as assess medical eligibility for participation in the California Children’s Services (CCS) program.
Children’s Case Managers participate as members of the multidisciplinary team to coordinate care. We coordinate patient care conferences that involve members of the multidisciplinary team and the family to address the needs of complex patients.
Areas of Expertise
Our areas of expertise include complex discharge planning and care coordination for post discharge needs as well as utilization management.
While we work with every discipline at the Hospital at some point - depending on the complex patient’s medical needs - we work very closely with the following:
Children's Home Care (a division of Children's Hospital) – Our collaboration with Children's Home Care allows us to manage discharge patients more effectively. Children’s Home Care supports a large number of patients using ventilators and with other complex medical needs.
Social Workers – Our Case Management Team works collaboratively with Social Workers on complex patients who have social, economic and psychological challenges to ensure a successful discharge.
Starship Inpatient Units - We meet needs specific to each patient.
The Rehabilitation Center – We work closely with Outpatient Therapy and Physical Therapy to coordinate care for complex patients.
Clinical Nutrition - We work closely with the Hospital's Dietitians.
Focused on Patient Throughput
Children’s Case Management expedites discharge plans for complex patients, making sure they can go home in a timely manner and opening beds for additional patients.