Clinical Management Nutr 564: Management Summer 2007

Clinical Management

Nutr 564: ManagementNutr 564: Management

Summer 2007Summer 2007

Objectives:• Contrast the functions of management as presented previously to the functions of clinical management

• Analyze tools available for clinical management

• Review the Nutrition Care Plan

• Review Care Pathways

Clinical Management

Concept Discussion

• Review the major topics we have covered this quarter and be prepared to discuss examples from clinical management.

Functions of Management

• Leadership / Management• Information Management• Time Management• Systems Management

Why?

Puckett ‘04

Management ActivitiesManagement Activities

1) Planning1) Planning

Strategic Planning: Setting GoalsOperational Planning

Defining ObjectivesDesigning the organization to achieve the

goals and objectivesAssigning responsibilitiesAllocating resourcesDesigning organizational controls

Planning• Examples from the reading • Policies, Procedures and Standards

(Also see p. 251 Puckett)• Planning for facility goals and objectives• Planning for program goals and objectives

• Personnel needs (education, travel)

• Planning for services – patient care

• Marketing Opportunities

Policies and Procedures

Purpose: Documentation

Internal purposesJCAHO requirements

StandardizationConsistency between personnel /

CommunicationEstablishes plan for revision and evaluation

• Examples

PolicesPolices

• Examples

ProceduresProcedures

Procedure Name: Review of interns records prior to start of program

Origination Date: July 13, 2004

Authorization: L Peck, B Bruemmer

Status: Active

Procedure Objective: Assure compliance with CADE guidelines

Personnel Involved NS Program Assistant/ DI Director

Schedule of Activity Yearly4th week of August

Personnel NS Program Assistant will:

Review documentation for incoming Dietetic Interns for:• One original complete transcript• DPD verification form• Submit these completed forms to the DI for review

DI Director will:• Confirm documentation• Note in DI log that records were reviewed and completed

Revision Status: Bi-annual (August)

References: CADE Accreditation Handbookhttp://www.eatright.org/Public/Files/accreditation_handbook.pdf

Definitions:

Distribution List: L Peck, B Bruemmer, B Winter-Eben, C Purnell

Forms & Resources:

Procedure Name: Student RD Exam Registration Eligibility

Frequency of Activity Yearly

Schedule of Activity: June

Procedure Objective: Identify DI graduates to CDR for eligibility to take RD exam

ProcedureDI Director

Two weeks before the end of spring quarter the eligible interns will be identified. Distribute Name/Address verification form to the interns

NS Program Secretary Prepares the CDR disk: Intern – name, social security number Prepares the DI verification forms – 5 per student:

DI Verification forms include: Code xxx; Title = ‘Director, Dietetic Internship’; Date; Student Name, SS number, date of completion of internship

Interns: Complete name/address verification form (sign and date in blue ink) Retain student copy Return CDR copy to Program Secretary

DI Director: Signs 5 original verification forms (blue ink) per intern

1 form to intern file; 4 forms given to intern at completion of DI Signs cover sheet for CDR

NS Program Secretary/ At completion of DI Copies CDR materials Sends disk to CDRSends name/address verification forms and cover sheet to CDR

2)2) ControllingControllingManagement control

Designing project controlsMotivating/ MonitoringReviewing ProgressSolving ProblemsLeadership, coaching and counselingPerformance appraisal

Measuring productivity

Management ActivitiesManagement Activities

Puckett ‘04

Measuring Productivity

• Determine the estimated variability in the time spent on each task.

• Evaluate patient acuity relative to staff services



Acuity:

Decisions about acuity are based on sensitivity and specificity models not on universal principles.

May be determined by:

•• Diagnosis

• • Screening

• • Clinical Status

• Match staffing to appropriate skill level

• Include estimates of cost-effectiveness/ quality assurance• Avoid the pitfall of only monitoring

processes and not outcomes


2)2) ControllingControlling

Operational controlSchedulingEstablishing procedures


Screening

Puckett ‘04

Objectives:

• Contrast the functions of management as presented previously to the functions of clinical management




Clinical Management

Definition

The ADA Nutrition Care Process is….

A systematic problem solving method tha dietetics professionals use to critically think and make decisions to address nutrition related problems and provide safe, effective, high quality nutrition care.

Nutrition Care Plan• A means of communication among all members of

the treatment team• A resource to be used in treating the patient’s

illness• A means of providing continuing patient care in

different health care settings.• An important tool in utilization management and

quality assessment programs.• A constant and valuable source of information for

research and educational and statistical studies• Proof of services provided (for reimbursement

documentation)• A document that can afford legal protection to the

health care facility, its employees and its patients.Puckett ‘04

Nutrition Care Plan

• What are the advantages to using the pathway?• Standardized language• Link to EBM• Focus is on delivery of quality care• Systematic documentation for reimbursement

Objectives:

• Contrast the functions of management as presented previously to the functions of clinical management




Clinical Management

Clinical Pathways

Clinical Pathways

Also known as:

Critical paths

Critical pathways

Care paths

Clinical Pathways

“Management plans that display goals for patients and provide the sequence and timing of actions necessary to achieve these goals with optimal efficiency”

Every NR et al. Circulation 2000;101:461-5.

Clinical Pathways Select the best practice when practice

varies unnecessarily

Defining the standards for the expected duration of hospital stay and for the use of tests and treatment

Examining the interrelations among the different steps in the care process to find ways to coordinate or decrease the time in the rate-limiting step

Clinical Pathways Giving all hospital staff a common game plan

from which to view and understand their various roles in the overall care process

Providing a framework for collecting data on the care process so that providers can learn how often and why patients do not follow an expected course during their hospitalization

Decreasing documentation burdens

Improving patient satisfaction with care by educating patients and their families about the plan of care

Clinical Pathways

Care delivery tool similar diagnoses

Identify level of care

Members of Health Care Team

Specifies time of intervention

Incorporates discharge planning & education

Clinical Pathways

BenefitsBenefits

Uniform care / reduces variation in care

Improves communication

Facilitates documentation

Supports quality assurance efforts

Clinical Pathways

LimitationsLimitations

Only useful if properly used in a timely fashion

Flexibility

Often many of the processes have not been tested

Not all variation is negative

Not an end in itself

Allow for identification of problems

Clinical Pathways

Examples: Information on patient’s nutritional care

Admission:

Screening -

Baseline data - Ht, Wt, IBW,

Nutritional Assessment - at risk statement

During hospitalization:Interactions

* Diet Instruction* Nutrition Support

Clinical Pathways

Examples: Information on patient’s nutritional care

Discharge Planning:EducationPlan for follow-up

Clinical Pathways

Sabo ‘05

Sabo ‘05

Clinical Pathways

Clinical Pathways

Steps in developing a care pathway Select a topic Select a team Evaluate the current process of care Evaluate medical evidence and current practice Determine the critical pathway formatDevelop the algorithmInclude documentation on the pathway

Document and analyze variance Pathway implementation Continuous Quality Improvement

Fuss: J Trauma Nursing; ‘98

Clinical Management Examples

McMahon ‘06

Clinical Management

Challenges

Organizational StructureHealth Care

Ancillary service

Documents

Clinical Management Nutr 564: Management Summer 2007