Case manager role definitions: do they make an organizational impact?

PURPOSE OF STUDY

This study examined 2 case management delivery models related to defined case manager role responsibilities in a large midwest hospital. Of interest was whether organization-wide outcomes related to reduction in length of stay (LOS) could be achieved by altering the case manager's role functions across medical, surgical, and cardiology units in general, intermediate, and intensive levels of care. In addition, there was curiosity about the timing of the admission and whether LOS would be influenced by the experience of the case manager with new role functions. The first model encompassed a traditional case management model where the case manager's primary functions were discharge planning and utilization review. The second model, the full immersion model, decreased the case manager's caseloads and expanded role functions to encompass daily expectations for chart review, electronic documentation, and communication with members of the interdisciplinary team.

PRIMARY PRACTICE SETTING

Acute care hospital inpatient medical, surgical, and cardiology care units.

METHODS AND SAMPLE

A causal-comparative retrospective study that included 39,017 medical, surgical, and cardiology inpatients who received care on general, intermediate, and intensive care units. Descriptive and inferential statistics were used to analyzed LOS in the traditional and full immersion models across clinical specialty units and levels of care. IMPLICATION FOR CASE MANAGEMENT PRACTICE: Statistically significant reductions in LOS were achieved using the full immersion model of case management across clinical specialties and levels of care. In addition, the timing of the admission during the implementation of the full immersion model was not statistically significant, highlighting that organizational impacts could be expected at the time of implementation of the model and that the experience of the case manager with the roles functions did not have a negative impact on achieving reduction in LOS with the full immersion model.