Tales from the Sub-Front

As a Director of Case Management and Social Services at a busy suburban Chicago medical center, the COVID-19 front looks different for me and my team. The case management RNs and social workers have been impacted by the virus in their work in a dissimilar way to the “frontline” healthcare staff performing direct patient care.

Professionals in the position of case manager assume the role of “advocates who help patients understand their current health status, what they can do about it, and why those treatments are important…by guiding patients and providing cohesion to other professionals in the healthcare delivery team, enabling their clients to achieve goals more effectively and efficiently,” per the Case Management Society of America (CMSA) Standards of Practice.

Inpatient case manager RNs and social workers assess a patient for any discharge needs and make the arrangement to link the patients with those services. Without them, the ins and outs of any hospital system come to a screeching halt. That would lead to serious backup in the system, and the newly ill would not be able to be admitted to the hospital for care. It’s critical work, especially in the current climate.

What our “frontline” looks like:

• To save on PPE for the facility, we have changed how we interact with our patients, adapting from in-person screening, assessment, and coordination to telephonic – sometimes completed with the patient, sometimes with family or friends – and keeping in mind that they may be missing those non-verbal cues that they rely on so much to direct them to identify gaps in care or the unspoken needs of the patient/family.
• There has been elation at the relaxed prior authorization rules for post-acute care that most of the managed care world has put forward (temporarily), tempered by the frustration of not being able to transition COVID-19-positive patients to the next level of care for lack of appropriate services/providers available in the community.
• We have been working on new ways to collect information so we can submit our reviews to the managed care organizations, in order to allow the hospital to continue to be reimbursed, while understanding the burden and limitations of the direct patient care professional who has that information.
• We have been connecting patients and families via whatever mode is possible: telephone, FaceTime, Zoom, Skype, etc. We have been creating opportunities to decrease isolation, reassure families, and sometimes, cope with those sad, horrible times, giving families an opportunity to say “goodbye.”

So, during this National Nurses Month – and Year of the Nurse and Midwife – don’t forget about the case management team members. They are a vital part of the “frontline,” helping to keep patient flow moving, reimbursement coming in, and most importantly, connecting patients/families with each other and the resources to be successful, post-discharge.