Maryanne Bourque, MS, BSN, RN, CRCR, is a registered nurse who has worked in pediatric health care for 35 years in both clinical and leadership roles. She holds a master's degree in health administration and currently serves in the role of Director of Case Management, Utilization Management, and the Complex Scheduling Team.
Donna DeFilippis, BSN, RN, ACM-RN, is a certified nurse case manager with 30 years of experience in clinical nursing, case management, and utilization management in the insurance environment and in the hospital setting. She is currently the Lead Nurse Case Manager for the Cardiac Center, serving as the clinical expert for case management.
Prof Case Manag. 2021;26(5):242-249. doi: 10.1097/NCM.0000000000000494.
PURPOSE/OBJECTIVES: Nurse case managers (NCMs) have been identified as effective members of a care team in the development of effective and successful discharge plans. A pediatric hospital had an opportunity to change the model of case management (CM) in response to multiple initiatives. This article describes the process, barriers, and results of the integration of a new role into the care team.
The role development and integration were done at a quaternary-level pediatric hospital.
FINDINGS/CONCLUSIONS: Introduction of the NCM role was accomplished through a multidisciplinary approach that employed continuous improvement, involvement of team and hospital leaders, and collaboration across multiple professions. The role was developed from one pilot to the eventual positioning of nine NCMs. Introduction of the new program resulted in a shift from a reactive dyad model of social worker-utilization management nurse to a proactive triad model of NCM-social worker-utilization management nurse. Success was measured by a decrease in the number of denials and an increase in the overturn of the denials received. Other results included the innovation of several processes that streamlined discharge planning and contributed to patient/family satisfaction.
Creation of a new nurse-led CM triad team can be accomplished through multidisciplinary support and a focus on continuous improvement. Further collaboration on discharge planning standards and CM is indicated. Additional research focused on the impact of nurse-led pediatric discharge planning as it relates to readmission reduction and appropriateness of level of care and length of stay is also needed.
目的/目标：护士个案经理（NCM）已被确定为制定有效和成功出院计划的护理团队的有效成员。一家儿科医院有机会针对多项计划改变病例管理（CM）模式。本文描述了将新角色融入护理团队的过程、障碍和结果。
角色发展和整合是在一家四级儿科医院进行的。
发现/结论：通过采用持续改进、团队和医院领导参与以及跨多个专业领域合作的多学科方法，成功引入了 NCM 角色。该角色从一个试点发展到最终设立了 9 个 NCM。新计划的引入将社会工作人员-利用管理护士的反应性二元模型转变为 NCM-社会工作人员-利用管理护士的主动三元模型。通过减少拒绝的数量和增加拒绝的推翻数量来衡量成功。其他结果包括创新了几个流程，使出院计划更加精简，并提高了患者/家庭的满意度。
通过多学科支持和关注持续改进，可以创建新的以护士为主导的 CM 三方团队。需要进一步合作制定出院计划标准和 CM。还需要进一步研究侧重于护士主导的儿科出院计划对减少再入院、护理水平和住院时间的适宜性的影响。
