Patient Care Coordinator in ED

Wuzzie · Nov 12, 2019

What's the job description? Where I work that's just a fancy term for a bedside nurse.

choksantos, BSN, RN · Nov 12, 2019

16 minutes ago, Wuzzie said:
What's the job description? Where I work that's just a fancy term for a bedside nurse.

It's so far from a bedside nurse where I work, they are off bed side, I would assume care coordination, speaking to families, patients and doctors and all the team, make sure patient will get care even if at home or make sure they get discharge to an appropriate place. But yes, I have a general idea but I want to hear from PCC's

Wuzzie · Nov 12, 2019

So it's a case management position. That helps clarify things.

KyBeagle, ASN · Nov 23, 2019

I’m an ED Care Coordinator. The role can encompass various duties, dependent upon the facility.

Regardless of where you work, it will have a huge component of ED discharge planning for the “complex” discharges (the fun ones that the bedside nurse truly doesn’t have time to handle). You may be setting up home health, outpatient infusion, detox/rehab, psychiatric services, prescription medication assistance, making MD office appointments, referring to local food banks, soup kitchens, finding openings in homeless shelters, DV shelters, etc.

You’ll have patients stranded 500 miles from home, asking for help to get back home. With these you’ll either 1). Genuinely be wanting to help —maybe it’s a survivor of a horrible MVA with other family fatalities. You’ll be pooling all resources & getting pretty creative, working WAY outside the box to get them assistance OR 2). It’s a boyfriend/girlfriend that moved from NYC to Louisville 1 year ago to live with boyfriend/girlfriend. They broke up. Now the one from NYC is in Louisville ED with 3 complaints... a toothache, an ingrown toenail & requesting help to get back to NYC. Correction... DEMANDING/ DICTATING that you get them back to NYC because nobody else in their family can come get them because of their DUIs, no car, no gas money, car is in the shop & no money for repairs, etc... (you might just get them directions to the local homeless shelter). Yes, these are real scenarios! (Just the diagnoses & their home city changed to avoid identification)...

No shift is EVER the same!

Depending on the facility, another component may be UM (Utilization Management). Reviewing all admissions to determine if they meet Medicare, Medicaid, Commercial insurance guidelines. Sound easy?? NOPE! It’s a lot of “detective work”, combing the chart, asking ED nurses if they can chart that O2 they applied, etc, calling MDs to clarify Inpatient or OBS status (when they’ve got it wrong), notifying patients that they don’t meet criteria for admission (a requirement of Medicare), etc. Medicare is making the admission criteria more difficult each year & the insurance companies are following their lead.

Some facilities include tracking high utilizers ( aka Frequent Fliers), and following up with them between visits.

Lots of different duties. And after 22 years on the floor, I’ve loved the past 5 years of ED RN Care Coordinator... and learned A LOT!

Editorial Team / Moderator · Nov 23, 2019

2 hours ago, KyBeagle said:
Medicare is making the admission criteria more difficult each year & the insurance companies are following their lead.

Working in appeals and using Milliman Care Guidelines has been a real eye opener!

KyBeagle, ASN · Nov 23, 2019

3 hours ago, Pixie.RN said:
Working in appeals and using Milliman Care Guidelines has been a real eye opener!

It’s been such a learning experience. Understanding WHY the “little things” are SO important to document, from the perspective of payment instead of liability. We use InterQual guidelines. Applying O2 via NC. Did the COPDer have retractions? Did the Possible CVA pass or fail the dysphagia screen? Any improvement after the IV Lasix in ED? And WHY is the CP being admitted as Inpatient status instead of OBS with a neg EKG, neg enzymes, neg CXR, PE ruled out, etc? (Oh- because nobody documented that the pt has hx of pulmonary fibrosis AND that they desaturated to 85% when ambulating to the BR in ED).

Yes. It’s been a real eye opener!

I look at myself now & realize that I’ve become “that nurse”... the “desk nurse” that is reminding the staff ED nurses to chart. I know what they’re probably (definitely) thinking about me because I used to be in their shoes, ?!