Care Management Unit Update

1. Care Management Unit Update Varnada Karriem-Norwood, MD Medical Director, Care Management Unit Asst. Medical Director Emergency Care Services Grady Memorial Hospital Asst. Professor Emergency Medicine, Emory University

2. Care Management Unit 7 Bed Unit 4 dedicated CMU Nurses 4 dedicated Case Managers Admission Criteria Chest Pain (Low to Intermediate Risk) Heart Failure Asthma Hyperglycemia

3. Admission Protocols Protocols developed via collaborative effort with other departments Cardiology (Heart Failure/Chest Pain) Internal Medicine (Heart Failure/Chest Pain) Endocrinology (Hyperglycemia) Pulmonary (Asthma)

4. Case Manager Duties Patient/Family disease specific Education (Case Managers trained) Primary Care Follow Up 48-72 hours Direct Phone follow up Database

5. Follow Up Primary Care Access Open Template to Neighborhood Clinics Daily appointments available Hospital Medical Clinic Chest Pain Outpatient DSE/Thallium available 48-72 hours Asthma Appointments available 48 hours Heart Failure Medical Clinic Follow up 48 hours Diabetes Follow up 48 hours in diabetes clinic

6. Goals Decrease number of short stay admissions Decrease number of admissions to telemetry beds Decrease cost Decrease relapse rate Patient Satisfaction

7. Total CMU Admissions

8. Statistics

9. Decrease Telemetry Admissions

10. Decrease Cost University Health System Consortium June 2002-2003 1,122 CHF admissions $4,472.00 per patient Average LOS 4 days (Below average) Cost Savings for CHF Avoided 34 hospital admissions ECC/CMU cost $616.28 � $1061.62 Total savings $3410.38 - $3855.72

11. Patient Satisfaction Patient satisfaction surveys being conducted on all patients by phone. Data not currently available.

12. Challenges Volume/Staffing Patient volume in zones decrease staffing availability in CMU (LPN�s, support staff) Critical nurse staffing and zone volume forced closing CMU for 8 hour period on three occasions Bed Capacity Need larger unit to admit more patients Protocols cannot be adequately done in zones Data (Telemetry and Specialty Bed Admissions) Difficult to extract data on total telemetry admissions No patient tracking system to determine revisit rates Lab/Radiology � slow turnaround times Two schools of Medicine Cardiology Fellows not available for all patients for in unit testing

13. Next 6 Months Continue as center for excellence Decrease subsequent admission rates Improved nurse staffing Improve documentation and compliance Analysis of Datapoints Decrease telemetry admissions Decrease number of short stay admissions Decrease relapse rate Patient satisfaction Cost savings

14. Next 6 Months Continued Medical Education for Case Managers Diabetes mini-residency Asthma Formal training/education for heart failure Evaluate case manager progress Established primary care % of patients that keep follow up appointments Patient Satisfaction