Clinical Management
Nutr 564: Management
Summer 2007
Clinical Management
Objectives:
• Contrast the functions of management
as presented previously to the
functions of clinical management
• Analyze tools available for clinical
management
• Review the Nutrition Care Plan
• Review Care Pathways
Concept Discussion
• Review the major topics we have covered this
quarter and be prepared to discuss examples
from clinical management.
Functions of Management
•
•
•
•
Leadership / Management
Information Management
Time Management
Systems Management
Why?
Puckett ‘04
Management Activities
1) Planning
Strategic Planning: Setting Goals
Operational Planning
Defining Objectives
Designing the organization to achieve the
goals and objectives
Assigning responsibilities
Allocating resources
Designing organizational controls
Planning
• Examples from the reading
• Policies, Procedures and Standards (Also see
p. 251 Puckett)
• Planning for facility goals and objectives
• Planning for program goals and objectives
• Personnel needs (education, travel)
• Planning for services – patient care
• Marketing Opportunities
Policies and Procedures
Purpose:
Documentation
Internal purposes
JCAHO requirements
Standardization
Consistency between personnel / Communication
Establishes plan for revision and evaluation
Polices
• Examples
Procedures
• Examples
Procedure Name:
Review of interns records prior to start of program
Origination Date:
July 13, 2004
Authorization:
L Peck, B Bruemmer
Status:
Active
Procedure Objective:
Assure compliance with CADE guidelines
Personnel Involved
NS Program Assistant/ DI Director
Schedule of Activity
Yearly
4th week of August
Personnel
NS Program Assistant will:
Review documentation for incoming Dietetic Interns for:
• One original complete transcript
• DPD verification form
• Submit these completed forms to the DI for review
DI Director will:
• Confirm documentation
• Note in DI log that records were reviewed and completed
Revision Status:
Bi-annual (August)
References:
CADE Accreditation Handbook
http://www.eatright.org/Public/Files/accreditation_handbook.pdf
Definitions:
Distribution List:
Forms & Resources:
L Peck, B Bruemmer, B Winter-Eben, C Purnell
Procedure Name:
Student RD Exam Registration Eligibility
Frequency of Activity
Yearly
Schedule of Activity:
June
Procedure Objective:
Identify DI graduates to CDR for eligibility to take RD exam
Procedure
DI Director
 Two weeks before the end of spring quarter the eligible interns will be identified.
 Distribute Name/Address verification form to the interns
NS Program Secretary
 Prepares the CDR disk: Intern – name, social security number
 Prepares the DI verification forms – 5 per student:
DI Verification forms include: Code xxx; Title = ‘Director, Dietetic Internship’;
Date; Student Name, SS number, date of completion of internship
Interns:
 Complete name/address verification form (sign and date in blue ink)
 Retain student copy
 Return CDR copy to Program Secretary
DI Director:
 Signs 5 original verification forms (blue ink) per intern
1 form to intern file; 4 forms given to intern at completion of DI
 Signs cover sheet for CDR
NS Program Secretary/ At completion of DI
 Copies CDR materials
 Sends disk to CDR
Sends name/address verification forms and cover sheet to CDR
Management Activities
2) Controlling
Management control
Designing project controls
Motivating/ Monitoring
Reviewing Progress
Solving Problems
Leadership, coaching and counseling
Performance appraisal
Measuring productivity
Measuring Productivity
Puckett ‘04
Measuring Productivity
• Determine the estimated variability in
the time spent on each task.
• Evaluate patient acuity relative to staff
services
Measuring Productivity
Acuity:
Decisions about acuity are based
on sensitivity and specificity
models not on universal principles.
May be determined by:
• Diagnosis
• Screening
• Clinical Status
Measuring Productivity
• Match staffing to appropriate skill level
• Include estimates of cost-effectiveness/
quality assurance
• Avoid the pitfall of only monitoring
processes and not outcomes
Measuring Productivity
2) Controlling
Operational control
Scheduling
Establishing procedures
Screening
Puckett ‘04
Clinical Management
Objectives:
• Contrast the functions of management
as presented previously to the
functions of clinical management
• Analyze tools available for clinical
management
• Review the Nutrition Care Plan
• Review Care Pathways
Definition
The ADA Nutrition Care Process is….
A systematic problem solving method tha dietetics
professionals use to critically think and make
decisions to address nutrition related problems and
provide safe, effective, high quality nutrition care.
Nutrition Care Plan
• A means of communication among all members of the
treatment team
• A resource to be used in treating the patient’s illness
• A means of providing continuing patient care in different
health care settings.
• An important tool in utilization management and quality
assessment programs.
• A constant and valuable source of information for research
and educational and statistical studies
• Proof of services provided (for reimbursement
documentation)
• A document that can afford legal protection to the health
care facility, its employees and its patients.
Puckett ‘04
Nutrition Care Plan
• What are the advantages to using the pathway?
•
•
•
•
Standardized language
Link to EBM
Focus is on delivery of quality care
Systematic documentation for reimbursement
Clinical Management
Objectives:
• Contrast the functions of management
as presented previously to the
functions of clinical management
• Analyze tools available for clinical
management
• Review the Nutrition Care Plan
• Review Care Pathways
Clinical Pathways
Clinical Pathways
Also known as:
Critical paths
Critical pathways
Care paths
Clinical 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 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 ratelimiting step
Clinical Pathways
 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
Clinical Pathways
Care delivery tool similar diagnoses
Identify level of care
Members of Health Care Team
Specifies time of intervention
Incorporates discharge planning & education
Clinical Pathways
Benefits
Uniform care / reduces variation in care
Improves communication
Facilitates documentation
Supports quality assurance efforts
Clinical Pathways
Limitations
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 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
Clinical Pathways
Examples: Information on patient’s
nutritional care
Discharge Planning:
Education
Plan for follow-up
Clinical Pathways
Sabo ‘05
Clinical Pathways
Sabo ‘05
Clinical Pathways
Steps in developing a care pathway
Select a topic
Select a team
Evaluate the current process of care
Evaluate medical evidence and current practice
Determine the critical pathway format
Develop the algorithm
Include documentation on the pathway
Document and analyze variance
Pathway implementation
Continuous Quality Improvement
Fuss: J Trauma Nursing; ‘98
Clinical Management Examples
McMahon ‘06
Clinical Management
Challenges
Organizational Structure
Health Care
Ancillary service