Care Transformation Center Blog

Auditing your care team: The before and after

Cabell Jonas

A few weeks ago, we shared our new white paper, which explores how leaders at LifeBridge Health, a 1,239-bed health system in Baltimore, Md., redefined key care management positions and made better staffing decisions by conducting a comprehensive care management staff audit.

Over a 9-month period, frontline staff representing LifeBridge Health's case management, social work, nursing, and employee education divisions met to discuss staff duties and daily workflow processes in the ED and inpatient settings. 

Here's how the audit changed staff roles across five areas at the organization.

Comparison before, after audit process

ED coverage

After comparing job descriptions across care management staff, the workgroups found gaps in ED coverage, particularly in overseeing patients at high risk of readmission.

In response, LifeBridge Health embedded an RN care manager in the ED to support care management functions on a daily basis and manage readmission reduction strategies. The system also created an electronic alert system that automatically fires when a patient at high risk of readmission presents at the ED.

This data is sent to the organization’s EMR, where it is posted to an “ED Patient Tracking Board.” As part of their training, ED care managers are educated to regularly check the Tracking Board to identify these high-risk patients, and immediately complete a patient assessment to reduce a future readmission.

Case management

Reviewing day-in-the-life summaries also revealed significant overlap in inpatient case management duties. These redundancies created confusion over task ownership and led to inefficiencies across departments.

In response, the workgroups streamlined staff functions in the inpatient setting. Before, LifeBridge Health had independent staff performing utilization review (UR) five days per week. Now, UR is a daily (seven days per week) function that is integrated into the RN care manager’s role. This change is meant to improve denials reporting by shifting accountability to the RN care manager, who is actively engaged in all aspects of patients’ care and can track denials as part of the clinical care routine.

Multidisciplinary rounding

Lastly, the workgroups uncovered that no single staff member was responsible for coordinating the inpatient multidisciplinary rounding process. This oversight resulted in different rounding practices across the organization and staff scheduling conflicts (i.e. physicians having to attend rounds at the same time on different floors of a unit).

In response, the workgroups assigned RN care managers to coordinate the multidisciplinary rounding process to ensure that specific individuals are responsible for standardizing protocols and engaging care management staff in the process. Since this staffing role change, RN care managers have scripted the rounding process where possible to ensure critical information is relayed to staff and patients in a consistent manner.

Ready to Audit Your Care Management Team?

Our new white paper explores LifeBridge Health's four-step audit process, offers takeaways for organizations looking to audit their teams, and includes updated job descriptions, day-in-the-life summaries, and multidisciplinary rounding scripting.


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Auditing the Care Management Team

Are you hiring the right care management staff? Find out by conducting an audit to redefine roles and identify gaps and redundancies in your team. Download the white paper.


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