Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_705_Библиотеки_им_академика_М_И_Перельмана

In order to maintain historical context and stay up-to-date, the CWH Co-Managers keep con­stant, meticulous track of all small- and wide­ranging clinical operations and events. This is done using shared, secure Google Spreadsheets, which are added to almost daily. These are as follows:

This document serves as a comprehensive

catalog and history for our department. It helps us to track stafng structures and hiring efforts, associate histories from hiring, clini­cal scheduling evolutions, timeline histories and next steps for active projects, relevant contact details throughout the hospital and entity, and step-by-step workow details for future use and ease of return.

issues we deal with in Management are incon­sistencies in our associates’ Time and Attendance. Another of our shared spread­sheets is for tracking their lateness, absences, and callouts. This allows for an at-a-glance look at the distribution of any of these patterns among our associates, and for quick access to information when we need to document or refer to the Attendance details in disciplinary documentation or sit-downs. Our associates

We also make a Google spreadsheet to track our associates’ Holiday Requests around Thanksgiving, Christmas, and New Year’s. This helps us to ensure adequate staff cover­age for clinic and equitable distribution of time out for each staff member during these holidays.

As a practice, we also all utilize the Practice Share Drive (“Limbshare”) to preserve, access, maintain, and update all clinic-related docu­ments, resources, workows, handouts, paper­work templates, etc.

(a) Clinical Operations Updates: These

(f) Guest Speakers and Multidisciplinary

The Managers show up as scheduled, we show up on time, and we make ourselves as visible as possible throughout the day. This lets our associates know that they can rely and depend on us and sets up an expectation that we want to see the same from them. As much as possible, we Managers try to do our jobs from central clinic locations during the day— the clinic hallways from a mobile worksta­tion, or in the Administrative areas where multiple other associates work. This allows us to keep a comprehensive eye and ear on the day’s events and interactions and helps encourage our associates to stay on task. We also make sure to let our associates know where they can nd us or how they can reach us throughout the day, so they know they can always get a Manager if needed. Keeping in the center of things helps us stay connected to and involved with all aspects of our opera­tions, allows for us to troubleshoot any issues which arise throughout the day in real time, and allows for our staff and Providers to stay in constant engagement with us in every facet of clinic.

– Constant Communication and

Transparency: Over-communication is both practiced and encouraged by Management. We share information with our team in every way, and as soon as possible—via email, face­to-face communication, team meetings, instant messaging, etc. We feel that as much as possible, our team should have access and insight to the same information we have as leaders (excluding any sensitive HR-related issues). This helps them to understand how we make decisions and to help them feel con­dent in their own engagements in their work­place and for their entity. They do not feel they are being deceived or withheld from in any way and appreciate that they are being kept up-to-date in real time. We have had many other practices tell us that often they nd out about major or minor hospital initiatives from our practice rst, since we are so proactive about getting this information out to our team as quickly as possible.

Providers, our team knows the Managers have their backs. We will do anything we can to help them in their success or support them through a challenging situation. We have seen them through school to higher degrees, been their references for continued endeavors, and received many words of gratitude for being strong examples and providing encourage­ment that was needed. There is truly no greater gift or gratication in this role.

We shall begin with denitions and standard roles of CM and SW, acknowledging that stafng models and roles and responsibilities vary con­siderably across institutions and corporations.1 From there we shall consider several cases, mov­ing from the straightforward to the complex, that illustrate the interventions that are undertaken by CM/SW.Finally we shall engage administration­level considerations that are germane to through­put and discharge planning and will comment on several process-improvement interventions which, in our local experience, have proved benecial.

The art and science of excellent patient care and optimal patient hospital throughput are cen­tered on collaboration and communication of the clinical team with the CM/SW team. To this end, the discharge plan ideally begins—on the limb services as on all other services—on the day of admission to the hospital. Every patient admitted to the hospital must have a discharge plan and a targeted discharge date (TDD). Limb patients, in particular, are fraught with many unique dis­charge challenges. We have ideal protocols, but also the reality of what our patients can do physi­cally, mentally, emotionally, and nancially. Protocols, it should be remembered, are created for patients, not patients for protocols! A new below- or above-the-knee amputee might best be served by spending time in acute rehabilitation, retraining her brain to avoid falling. A partial­foot amputee will have the best potential for heal­ing by remaining non-weight bearing in a posterior splint. A free-ap patient would benet from weeks of ofoading in an external xator. But the truth of the matter is that non-weight bearing is often unrealistic for this patient popu­lation. They are deconditioned and laden with comorbidities including contralateral weakness or bilateral wounds. As a result, the ideal “dis­charge” is just a hypothetical “starting point,” and each discharge plan, pathway, and strategy must be tailored to the individual. Our inpatient nurse practitioners are uniquely skilled at bridging the gap between the ideal and the realistic discharge. Through extensive collaboration with the physi­cians, case managers, social workers, and the patients, they are able to create unique, patient­centered care plans. In order to better examine such challenges as we face during the hospital­ization and the eventual discharge process, we present three case studies to highlight the nuances of this complex population.