Bay Regional Health Sciences Centre, like all acute care hospitals
is facing increasing demands on it’s resources. As a
result, many patients require post-hospital care. The need
may be for rehabilitation, community support services, long
term care or transfer to other communities. These plans must
be organized prior to the day of discharge. Successful utilization
management results from thorough assessments and team work
which begins on the day of admission to hospital.
Patients and families are responsible for many aspects of their own plan for the care they will need after leaving the hospital. Each member of the health care team involved with the patient provides information about various alternatives available to assist the patient with his/her plan to meet their needs.
On Admission - Nursing staff begin an assessment of:
- patient’s medical condition
- home situation
- any problems which may affect discharge
The assessment is documented on the Patient Progress Notes.
During Hospital Stay - the patient’s
progress is reviewed at weekly interdisciplinary team meetings
to ensure appropriate planning.
Ongoing Communication - between all team
members, including physicians and patient/family is essential.
Case Conferences - with the patient, caregivers, physicians and team members are held for complex situations.
To conduct concurrent review based on clinical criteria to screen admissions for high risk discharges to act as a resource person to patients, caregivers, and staff to facilitate appropriate and effective use of acute care and community resources to accept referrals from any service in the hospital regarding patients who require:
- CCAC-Placement application - LTC/Chronic/Respite St. Joseph’s Programs:
Transition - Hospice - Reactivation - Rehabilitation - Day Programs
- Psycho geriatric Assessments Geriatric Assessments Discharge Planning Case Conferences
- To act as liaison for CCAC-Placement, Long Term Care Facilities,
St. Joseph’s Chronic/Rehab Programs, LPH Psycho geriatric
Community Assessment Team and other Community Agencies to
designate Alternative Level of Care to identify patients
who meet the criteria for copayment
Patients who no longer require acute hospital care and are waiting for transfer to Rehabilitation, Long Term Care, Chronic Complex Care or Home Care.
Copayment: according to Ministry of Health guidelines, patients waiting in hospital for Long Term Care and who are more or less a permanent resident in hospital will be charged a copayment.
Utilization Coordinators are available from 8:00 a.m. to
4:00 p.m. Monday to Friday, excluding statutory holidays.
Call switchboard to page.
Utilization Co-ordinators are Registered Nurses responsible for: concurrent and retrospective chart reviews using InterQual criteria; identifying trends and making recommendations to increase efficiencies in utilization and resource management; data analysis; screening admissions for high-risk discharge planning; and facilitating referrals to other community facilities/agencies including long term care, chronic care, rehabilitation and community agencies.
Physician Advisors work with the Utilization Co-ordinators to: monitor and continued stays that do not meet established criteria for acute level of care; follow up with medical staff on identified utilization issues; and provide clinical expertise and guidance to the Utilization Management Program.
Clerical staff are responsible for: booking
air ambulance transfers; receiving bed offers & notifying
the patient's nurse; preparing monthly statistical reports;
reception; in addition to photocopying; faxing; and typing
Utilization Management Team
Manager, Utilization Management
Thunder Bay Regional Health Sciences Centre
980 Oliver Road
Thunder Bay, Ontario
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