Utilization Management
Siužetinės Linijos Tekstas
- Midnight
- EMERGENCY
- Sam was in a car accident and taken to hospital and admitted to ICU
- step 1
- ...the next morning
- ICU
- Rx
- Hi, my name is Jamie, I'm the Utilization Review Nurse
- UR Nurse reviews Sam's medical record and documents all of his medical problems and treatments
- Step 2
- Now the UR nurse will communicate with the UR nurse at Sam's health ins. co.
- Meanwhile...
- Great! looks like Sam is receiving the correct level of care!
- I'm checking my protocols to make sure that the ICU is the best place for Sam to be treated.
- Rx
- •ICU
- Protocols
- step 3
- But, on occasion...
- Protocols may sometimes suggest a different level of care that would be more appropriate. When this occurs, the UR nurse discusses with patient's doctor.
- step 4
- •Step-Down Unit
- Protocols
- Hello Doctor, do you have a moment to discuss this patient's level of care?
- Protocols suggest Step-Down Unit is best for Sam's care
- side step 5A
- Scenario 1
- Yes, and I can also provide additional information, which makes it clear that this patient is right where he should be.
- Hello Doctor, my protocols indicate that patient should be in Trauma Center ICU.
- Protocols
- •Trauma Center ICU
- Protocols suggest the regional trauma center's trauma ICU
- Scenario 2
- Let's work together to get this patient where he needs to be.
- Side step 5B
- UR Nurse, Ins. Co.
- follow step 3 - alternate path
- UR Nurse, hospital
- Follow step 3
- Hi, I'm calling about patient Sam...
- Hello, thank you for calling ACME Health Plan
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