How many visits per day? (Case Management)

4boysmama · Dec 2, 2015

Depending on the day, usually 4-6. If one is an admission, then usually just 3

nutella, MSN, RN · Dec 3, 2015

When I was a hospice case manager my productivity was five visit per day.

Admissions counted for 2 visits, re-certifications for 1.5. Five visits is doable especially when your patients are geographically on the closer side. To help with efficiency I did chart as much at POC as possible into the computer and would sit in the car for another 10 minutes or so to finish up the note. Admissions take longer for hospice and I would finish the note at home or in the office.

If you are new to the job I can recommend to stock your car with things most often needed and available through your company (foley insertion materials, syringes without needles for meds, huber needles to access VADs , some dressing materials....) and to create two binders. One with important information you will need a lot for day-to-day operation like phone numbers, standing orders, clinical guidelines for things like palliative sedation, CADD pump instructions, FAST scale and so on. The other binder with sheet protectors has a variety of forms from hospice revocation to nursing facility instruction sheets for recommendations. I also have some extra admission paper work kits in my car in case I am out in the field and get a call to do an admission. Especially if you are also working on call/weekends/ holidays make sure you have enough pronouncement forms!!!

BerryhappyRN, MSN, RN · Dec 4, 2015

At my hospice RNCM's are expected to make 19 visits per week to be considered productive. This is easy when your caseload is over 14, sometimes a strain if the caseload is under 12 or under. I like to load up the beginning of the week, sometimes making 5-7 visits Mon through Wed and then taper down on Thurs and Fri.

Also, I agree with nutella. Finish your charting while you are with the patient or in the car afterwards. If not you will get pulled into lots of other work which will force your charting to be done at the end of your day, sometimes well into your evening. Remember your charting is just as important as your assessment so get them BOTH done in a timely manner.

nurseontheway · Dec 9, 2015

Thank you for all of the advice!

HeavenlyRN · Dec 13, 2015

I am new to hospice nursing, but I find that 4 visits a day is more than enough for me. Between all of the excessive documentation that is required and the phone calls/care coordination that happens in-between, I cannot imagine doing more than 4 visits in one day. so far my hospice does not have a minimum number of visits required for the week and I hope it stays that way.

Jensmom7, BSN, RN · Dec 13, 2015

I am new to hospice nursing, but I find that 4 visits a day is more than enough for me. Between all of the excessive documentation that is required and the phone calls/care coordination that happens in-between, I cannot imagine doing more than 4 visits in one day. so far my hospice does not have a minimum number of visits required for the week and I hope it stays that way.

Unless you are doing a butt-ton of driving between patients, 4 visits is not usually enough for a full days' work. The majority of your visits will be 30-45 minutes. Not every visit requires phone calls and care coordination every time. And, as you become more experienced, it will get easier.

How involved are your notes that you feel it is "excessive documentation"?? My agency uses a double sided note with check lists for systems review and room for narrative. Takes about 15 minutes to finish.

Don't forget, you're part of a team. You don't have to manage all the things. You have a Chaplain, Social Worker, Volunteer Coordinator and Bereavement Coordinator to assist with Psych/Soc issues and make extra visits if needed (Chaplain and SW frequencies are generally 1-2xmonth + 3prn unless they identify a need for more).

My agency requires 5-6 visits/day. My patients are all in one facility, so I have no problem meeting productivity. Some weeks I get tapped to go to some of the other facilities and do evals or help with visits. I refuse to bring work home with me (a boundary I had to set to keep myself from becoming totally stressed and overwhelmed), so my notes are all completed by the end of the day.

I guarantee that at some point your agency *will* address productivity-they are a business, after all.

HeavenlyRN · Dec 13, 2015

Clearly every agency situation is different. I stand by what I said about the requirements at my hospice. I do facilities as well, but all of my patients are NOT in the same facility. If that were the case, I could easily do 5 visits per day. And our documentation does NOT take 15 minutes (I wish it did only take that long!)

My productivity is not an issue as I do what is required and more to take care of my patients. Glad your situation is working for you but remember everyone's situation is different and cannot always be compared.

PurpleDaisyðŸŒ¸ · Dec 14, 2015

Unless you are doing a butt-ton of driving between patients, 4 visits is not usually enough for a full days' work. The majority of your visits will be 30-45 minutes. Not every visit requires phone calls and care coordination every time. And, as you become more experienced, it will get easier.
How involved are your notes that you feel it is "excessive documentation"?? My agency uses a double sided note with check lists for systems review and room for narrative. Takes about 15 minutes to finish.
Don't forget, you're part of a team. You don't have to manage all the things. You have a Chaplain, Social Worker, Volunteer Coordinator and Bereavement Coordinator to assist with Psych/Soc issues and make extra visits if needed (Chaplain and SW frequencies are generally 1-2xmonth + 3prn unless they identify a need for more).
My agency requires 5-6 visits/day. My patients are all in one facility, so I have no problem meeting productivity. Some weeks I get tapped to go to some of the other facilities and do evals or help with visits. I refuse to bring work home with me (a boundary I had to set to keep myself from becoming totally stressed and overwhelmed), so my notes are all completed by the end of the day.
I guarantee that at some point your agency *will* address productivity-they are a business, after all.

The agency I work for is very much into productivity and we are expected to see 4 patients (max 5, depending on acuity, driving, etc).

pfeliks · Dec 18, 2015

4 visits a day is the goal at the Hospice at which I work. But visits are weighted differently. Routine=1 Recert=2 admission =3.

Raicho, BSN, MSN, RN · Nov 9, 2016

Hi Nutella,

Did you have a laptop stand in your car? If so, did you like it and where did you get it? If not, how, physically did you do your charting in your car?

Thanks!

makeitwork, BSN, RN · Jan 2, 2017

"The majority of your visits will be 30-45 minutes."

A short visit for me would be 45 minutes. We not only talk to the patient/family providing emotional support and education, but, we do the assessment, medication reconciliation, orders (as needed), calls to the pharmacy for med delivery, maybe fill a medi-set, wound care if needed, and any other treatment required. My visits are usually over an hour long. If I was just seeing patients in a facility where staff nurses are doing treatments and getting most orders then I would consider "5-6 visits/day" an easy day. It is good to keep things in perspective. I agree with HeavenlyRN.