The Big Picture

Coordinating Inpatient Care for Medically Complex Patients

A 75-year-old man has a hip replacement. It's a straightforward procedure. But the patient has diabetes and heart disease, so the risk of complication is high. But if the patient has a care manager, chances are good that surgery will be successful and recovery uneventful.

Promoting Quality Care

"Most of our patients are medically complex," says Sandy Hilliker, director of nursing operations for care management at Fairview Southdale Hospital. "Our job is to see the big picture so we can promote quality care that is also cost effective."

Hospital care managers work collaboratively with the patient, the family and the physician to create a plan of care and ensure that it is carried out. Other members of the team include social workers, nurses, and various health and community service providers.

Managing a Hip Replacement

When a medically complex patient needs a hip replacement, the care manager becomes involved immediately after the procedure. The manager reviews the patient's records and then, working with the physician, patient and family, develops the plan of care.

During the hospitalization, the care manager watches the patient closely, sees that necessary tests are done promptly and checks the results to ensure that medications are correctly adjusted. The manager collaborates with the physician to address any special needs stemming from other medical conditions like diabetes or heart disease.

"We discuss rehabilitation and ask whether the patient has any concerns," Hilliker says. "If the patient lives alone or the spouse doesn't drive, we consult with a social worker who makes arrangements for physical therapy. We may also ask the social worker to arrange home care or address the patient's financial concerns."

A Different Type of Nursing

Successful care managers need a four-year degree and at least five years experience in medical/surgical or critical care nursing. They should have good critical-thinking and problem-solving skills, as well as the ability to multi-task. Good communication and interpersonal skills are also essential.

"Care management is a different type of nursing," Hilliker says. "I like working from a high level to improve processes, identify issues and remove roadblocks so the clinical team can provide better care."

Putting Your Experience to Work

Are you an experienced nurse who wants to use your clinical skills in a new way? Then consider care management. "It's ideal for mature nurses," says Sandy Hilliker, who directs care management at Fairview Southdale Hospital. "It's exciting and interesting, but it doesn't require tasks like lifting and turning patients."

Nancy Giguere is a freelance writer from St. Paul who has written about healthcare since 1995.