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Summary C 823 Task 1 A FINAL CH.docx C823 Case Management Notification for Dementia Patients in the Emergency Department Western Governors University College of Health Professions Clinical/Organizational Problem The problem identified is the need for early$4.99
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Summary C 823 Task 1 A FINAL CH.docx C823 Case Management Notification for Dementia Patients in the Emergency Department Western Governors University College of Health Professions Clinical/Organizational Problem The problem identified is the need for early
C 823 Task 1 A FINAL CH.docx C823 Case Management Notification for Dementia Patients in the Emergency Department Western Governors University College of Health Professions Clinical/Organizational Problem The problem identified is the need for early care management (CM) notification for patie...
c 823 task 1 a final chdocx c823 case management notification for dementia patients in the emergency department western governors university college of health professions clinicalorganizationa
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C823
Case Management Notification for Dementia Patients in the
Emergency Department
Western Governors University
College of Health Professions
Clinical/Organizational Problem
The problem identified is the need for early care management (CM) notification for patients with
dementia that arrive at the emergency department (ED). This population often arrives with coexisting
complex social issues that lead to discharge barriers.
This patient demographic has shown an increase in numbers in the eight years that this writer has
worked in the ED. In particular, those patients with behaviors such as aggression, destroying property,
and escaping their living environment are arriving at the ED in larger numbers each year with no pre-
notification. This demographic is labor-intensive from a nursing and CM perspective and requires human
and other resources that are not budgeted for or available. Furthermore, discharge can be problematic if
the individual continues to show aggression while in the ED. As a result, these existing behaviors may no
longer be welcome at their discharge destination and detours the expected discharge from the ED.
Consequently, this will result in an extended stay which can result in an increase in patient falls,
sundowning, and attempts to flee the facility, which further strains limited resources.
Description of Problem
The lack of pre-notification to CM inherently creates a myriad of issues at the time the patient is
to be discharged from the ED. Since CM is very often unaware of the discharge issues until the time of
discharge, no resolution of the patient’s issues have been in process while the patient is in the ED. This
, 2
results in a tardy CM referral that is now taking place four to five hours after the patient has arrived at the
ED. Therefore, many of the barriers that may have had the opportunity to be resolved during the patient’s
ED visit have not been initiated.
Consequently, these patients remain in the ED for an extended period of time unnecessarily and
occupy a much-needed bed. The end result is an extended stay in the ED, which can be anywhere from
five hours to forty-eight hours, which is beyond the four hours that the patient has already been in the ED
for a medical workup. The reverberation is felt by staff as resources are strained due to this population
requiring more attention than an already saddled nurse can manage.
Explanation of Causes
The lack of early CM notification by the registered nurse (RN), based on Emergency Medical
Services’ (EMS) report, precludes the interception of discharge barriers during an ED visit. This is due to
the lack of ED staff recognizing identified triggers that indicate the need for case management
intervention. The current practice relies on the experience and expertise of the nurse who either does not
recognize the CM need based on EMS report or forgets to call CM due to competing responsibilities.
Oftentimes, the staff assumes that a patient has a discharge destination without considering the variables
that brought the patient to the ED in the first place. This assumption can lead to issues that prohibit a
timely discharge.
Identification of Stakeholders
Stakeholder Interest Power Influence
Patient Timely CM referral Yes-patient has the Yes-integration of
will minimize stay in ability to initiate expedited referrals
ED. Thus, decreasing referral based on creates an efficient
the risk for delirium, presentation. discharge process.
sundowning, and falls.
RN Initiating a CM referral Yes-the nurse has the Yes-the nurse has the
will benefit the RN in ability and power to most influence on the
terms of time lead the change in how frontline receiving the
management and this population is report from
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