Clinical ManagementClinical Management
Nutr 564: ManagementNutr 564: Management
Summer 2003Summer 2003
Clinical ManagementClinical Management
Objectives:Objectives:
•• Review the functions of managementReview the functions of management
•• Identify unique challenges of clinicalIdentify unique challenges of clinical
management in nutrition/ dieteticsmanagement in nutrition/ dietetics
•• Review Nutrition Care Process Review Nutrition Care Process
•• Review Care PathwaysReview Care Pathways
Clinical ManagementClinical Management
Functions Functions
Resource management
• Allocation of resourcesTime, Physical resources, $
• Patient acuity
Clinical ManagementClinical Management
AcuityAcuity:
Decisions about acuity are based on sensitivity and specificity models not on universal principles.
May be determined by:
•• Diagnosis
• • Screening
• • Clinical Status
Clinical ManagementClinical Management
Functions Functions • Administrative dutiesAdministrative duties
BudgetPlanningStrategic PlanGoals & Objectives
Clinical ManagementClinical Management
Functions Functions • Personnel managementPersonnel management
Teams/ Leadership/ Organizational behaviorCulture of Health Care and DieteticsChange managementRisk managementRecruitment/ TrainingPerformance EvaluationsRetention
Clinical ManagementClinical Management
Objectives:Objectives:
• Review the functions of management
•• Identify unique challenges of clinicalIdentify unique challenges of clinical
management in nutrition/ dieteticsmanagement in nutrition/ dietetics
• Review Nutrition Care Process
• Review Care Pathways
Clinical ManagementClinical Management
ChallengesChallengesOrganizational Structure
Health CareAncillary service
Clinical ManagementClinical Management
Objectives:Objectives:
• Review the functions of management
• Identify unique challenges of clinical
management in nutrition/ dietetics
•• Review Nutrition Care Process Review Nutrition Care Process
•• Review Care PathwaysReview Care Pathways
Nutrition Care ProcessNutrition Care Process
Nutrition Care Process and Model: ADA Nutrition Care Process and Model: ADA adopts road map to care and outcomes adopts road map to care and outcomes managementmanagement
Lacey K, Pritchell E, JADA 2003;103:1061-72
Nutrition Care ProcessNutrition Care Process
Four Distinct Steps Four Distinct Steps
Not a linear relationship but based on critical thinking
Nutritional AssessmentNutritional Assessment
Nutrition DiagnosisNutrition Diagnosis
Nutrition InterventionNutrition Intervention
Nutrition Monitoring and EvaluationNutrition Monitoring and Evaluation
Nutrition Care ProcessNutrition Care Process
Consistent components and formats: Consistent components and formats:
• Definition and Purpose
• Key components or substeps with examples as appropriate
• Critical thinking characteristics
• Documentation elements
• Considerations for continuation, discontinuation, or discharge of care
Nutrition Care ProcessNutrition Care Process
How does this differ from MNT?How does this differ from MNT?
Some commonalities:
Consistent
Standardized
Four-step process
Process implemented differently in MNT types of service
MNT always involves comprehensive assessment and individualized care
Nutrition Care PlansNutrition Care Plans
Internal documents to support patient careInternal documents to support patient care
Summary of relevant patient information
Problem oriented
Problem orientedProblem oriented
Problem #1 - Medication induced Diabetes
Problem #2 - Uncontrolled HTN
Problem #3 - Social Support
Nutrition Care PlansNutrition Care Plans
Documentation should support the Nutrition Care Process
What information needs to be consistently tracked and recorded?
Nutrition Care PlansNutrition Care Plans
Patient Management:Patient Management:
Information management
Goals and Objectives
Clinical PathwaysClinical 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 PathwaysClinical 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 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
Pearson SD, et al.: Ann Intern Med 1995;123:941-8.
Clinical PathwaysClinical Pathways
Care delivery tool similar diagnosesCare delivery tool similar diagnoses
Identify level of care
Members of Health Care Team
Specifies time of intervention
Incorporates discharge planning and education
Clinical PathwaysClinical Pathways
BenefitsBenefits
Uniform care / reduces variation in care
Improves communication
Facilitates documentation
Supports quality assurance efforts
Clinical PathwaysClinical 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 PathwaysClinical Pathways
Steps in developing a care pathwaySteps in developing a care pathway Select a topic Select a team Evaluate the current process of care Evaluate medical evidence and current practiceDetermine the critical pathway formatAlgorithmInclude documentation on the pathway
Document and analyze variance Pathway implementationContinuous Quality Improvement
Clinical PathwaysClinical 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