Introduction of managed care plans in a cardiac surgery unit

Suzanna Kingsland
Consultant and Educator, Fairfield Hospital, VIC

Penny Smith
Clinical Nurse Manager, Cardiothoracic Unit, Royal Melbourne Hospital, VIC

Sharon McKinley
Professor, Critical Care, Royal North Shore Hospital, Sydney NSW

PP: 189 - 194

Abstract

Changes to output-based funding for health care as occurred recently in Victoria, and the goal of continuous improvement in quality of care, have provoked a rationalization of resource utilization and a greater focus on the process and outcomes of care in acute hospitals.

The use of clinical management plans (CMPs) to monitor the efficiency of processes and the achievement of outcomes (managed care systems) is one approach to these challenges. A pilot study undertaken in the cardiac surgical unit at the Royal Melbourne Hospital is used to highlight the major considerations that need to be addressed when administering CMPs. There were the multidisciplinary, patient-focused approach of the managed care system, integration of the plans into the patient documentation system and the opportunities offered to research by variance analysis.

| More

Keywords

managed care, critical paths, exception-based charting

View references

References

Burke L and Murphy J (1988) Charting by exception: A cost effective, quality approach. John Wiley, Aurora HC.

Cline A (1989) Streamlined documentation through exceptional charting. Nursing Management 20(2): 62-64.

Derr S Dill (1992) A comparison of four nursing documentation systems. Journal of Nursing Staff Development Jan-Feb: 26-31.

Health and Community Services March (1993a) Victoria's Health Reforms. The First Step. Casemix Funding for Public Hospitals. Discussion Paper. Health Policy and Programs. Victorian Government Department of Health and Community Services.

Health and Community Services June (1993b) Casemix Funding for Public Hospitals, Victoria's Policy. Victorian Government Department of Health and Community Services.

Metcalf E (1991) The orthopaedic critical path. Orthopaedic Nursing 10(6): 23-31.

Michael R (1991) Case based funding-how or when. Australian Health Review 14(3): 245-254.

Murphy J, Beglinger JE and Johnson B (1988) Charting by exception: Meeting the challenge of cost containment. Nursing Management 19(2): 56-72.

Olivas G, Del Togno-Armanasco V, Erickson J and Harter S (1989) Case management-A bottom-line care delivery model. Part 1. The concept. Journal of Nursing Administration 19(12): 16-20.

Spath PL (1993) Critical paths: A tool for clinical process management. Journal of American Health Information Management Association 64(3): 48-58.

The Toronto Hospital (1991) Managed care manual. Toronto Hospital, Toronto, Canada.

Zander K (1992) Critical pathways. In Melum M and Sinioris M (eds) Total quality management. The health care pioneers. American Hospital Pub., Chicago, pp.305-314.

Zander K (1988a) Nursing case management. Resolving the DRG paradox. Nursing Clinics of North America 23(3): 503-520.

Zander K (1988b) Managed care within acute care settings: Design and implementation via nursing case management. Health Care Supervisor (2): 27-43.

Bibliography

Barnsteiner JH, Mohan A and Milberger P (1992) Implementing managed care in a pediatric setting. AACN Clinical Issues in Critical Care Nursing 3(4): 777-787.

Bower K (1988) Managed care: Controlling costs, guaranteeing outcomes. Definition 3(30): 1-3.

Cohen EL and Cesta TG (1993) Nursing case management: From concept to evaluation. Mosby, St Louis.

Graybeal K, Gheen M and McKenna B (1993) Critical pathway development: The Overlake model 24(4): 42-45.

Giuliano KK and Poirier CE (1991) Nursing case management: Critical pathways to desirable outcomes. Nursing Management 22(3): 52-55.

Hampton DC (1993) Implementing a managed care framework through care maps. Journal of Nursing Administration 23(5): 21-27.

Lumsdon M and Hagland M (1993) Mapping care. Hospitals & Health Networks Oct 20: 34-40.

Olivas G, Del Togno-Armanasco V, Erickson J and Harter S (1989) Case management: A bottom-line care delivery model. Part 2. Adaptation of the model. Journal of Nursing Administration 19(12): 12-17.

Zander K (1988) Nursing case management: Strategic management of cost and quality outcomes. Journal of Nursing Administration 18(5): 23-30.

Navigate: Archives | Contents | Top of page

Sign Me Up

*Email Address
First Name
Surname

Web Feed

Latest Articles

Special Issues

Indigenous Health Care (2nd edn)
Volume 37/1

Nursing Workforce and Workplaces
Volume 36/1
Summary

Modeling of Clinical Nursing Care
Volume 35/1
Summary

Advances in Contemporary Mental Health Nursing – Second Edition
Volume 34/2
Summary | Contents

Advances in Contemporary Nursing and Gender
Volume 33/2
Summary | Contents

Advances in Contemporary Nurse Education
Volume 32/1-2
Summary | Contents

Advances in Contemporary Nursing: History of Nursing and Midwifery in Australasia
Volume 30/2
Summary | Contents

Advances in Contemporary Transcultural Nursing: Pathways to Cultural Awareness (2nd edn)
Volume 28/1-2
Summary | Contents

Advances in Contemporary Palliative and Supportive Care
Volume 27/1
Summary | Contents

Advances in Contemporary Aged Care: Retirement to End of Life
Volume 26/2
Summary | Contents

Advances in Contemporary General Practice Nursing: Role of the Practice Nurse
Volume 26/1
Summary | Contents

Advances in Contemporary Nurse Recruitment and Retention: Problems and Challenges in Human Capacity Development
Volume 24/2
Summary | Contents

Advances in Contemporary Community and Family Health Care
Volume 23/2
Summary | Contents

Advances in Contemporary Indigenous Health Care (1st edn)
Volume 22/2
Summary | Contents

Advances in Contemporary Nursing and Interpersonal Violence
Volume 21/2
Summary | Contents

Advances in Contemporary Mental Health Nursing (1st edn)
Volume 21/1
Summary | Contents

Advances in Contemporary Child and Family Care
Volume 18/1-2
Summary | Contents

Advances in Contemporary Transcultural Nursing (1st edn)
Volume 15/3
Summary | Contents



Website by Arrowsmith Websites. Business, Government & Corporate Websites, Web Hosting, Domain Names & SEO. Maleny, Sunshine Coast, Australia.