HC405 Business Finance

Describes the importance of managing the continuum of care to ensure that patients are treated in the right environment of care. Data and quality metrics are used in several ways to facilitate care management. Criteria sets and indicators are used to determine whether a patient was appropriately admitted to the hospital, receives the right care, and gets discharged at the right time. this assignment challenges students to analyze admission criteria and identify the use of preadmission screening, utilization management and discharge planning.

We need criteria to assess the preadmission, care management and discharge process as a mean of determining the quality of patient services offered in any hospital setting. This is because, a set criterion for assessment ensures uniformity in the way services are rendered to the patients in any hospital and hence acts as a standardization tool for the quality of services offered to patients in all hospitals across the country. Secondly, controlling the quality of services in hospitals will ensure that the step-by-step cycle of care is followed to the later. This will work to ensure that all the stages of the patient care cycle are implemented by way of offering quality services by the book. Finally, the implementation of these stages of the cycle of care and quality control will ensure that patients are treated in the right manner and in an appropriate environment. This, therefore, implies that we need set criteria to assess the preadmission, care management, and discharge process so as to ensure quality patient services, to enhance careful step-by-step patient care, and to ensure that patients are treated in the right manner and environment.

In this case study, the patient does not meet the criteria for admission to the hospital. This is because in order to be admitted to the hospital the patient needs to meet at least one criterion in the severity of illness category and one in the intensity of service category. In this case, the patient only meets one criterion for admission in the intensity of service category that is the ‘inpatient-approved surgery or procedure within 24 hours of admission’ (Shaw and Carter, 2015, p. 157). This is so since the doctor who reviewed her indicated as part of the patient’s care plan that he intends to operate on the patient later that night. The patient, however, did not meet any criteria for admission in the severity of illness category and hence does not meet the requirements for admission in the hospital.

In conclusion, the preadmission screening process is very important as it determines the kind of care that a patient is going to receive. It also dictates the nature of nursing goals and interventions that a nurse will include in their nursing plan as appropriate for specific patients (Murer, Lyndean and Murer, 2011, p.56) and the kind of drugs that a patient will receive.  When and if patients are not appropriately screened they could develop complications because of undiscovered illnesses that lay within. It could lead to the use of wrong drugs and doses that might not help to alleviate the patient’s condition but make it worse with resultant unnecessary development of dependencies and tolerance to the wrong drug. The implications to the patient are possible worsening of their current conditions, possible development of complications, and the possibility of incurring more costs as they seek treatment for the resultant complications. The implications for the hospital include the threat of being sued for giving inappropriate treatment options to patients.  Also, the risk of incurring unnecessary costs in compensating patients for time wasted and for costs incurred unproductively.

References

Murer, C. G., Lyndean, L. B. and Murer, A. M. (2011) . The Case Management Workbook: Defining the Role of Physicians, Nurses and Case Managers.  New York: Taylor & Francis Group

Shaw, P. L. & Carter, D. (2015) . Quality and Performance Improvement in Healthcare: Theory, Practice, and Management, 6^th ed. Chicago: AHIMA