Gatekeeper is one key role of case managers embedded in emergency departments, according to Toni Cesta, PhD, RN, FAAN, senior vice president of operational efficiency and capacity management at Lutheran Medical Center. Other roles include:
- Facilitate initiation of care
- Start intake/utilization process
- Encourage use of reimbursable diagnoses
- Interface with community agencies
- Create plans for high utilization patients
- Refer patients to other/more appropriate hospital areas
- Monitor and manage variances — elements that are misuse of resources or issues that may extend length of stay. For example, sending a patient to the ED for what would normally be an outpatient workup.
“When we talk about the roles and functions of the ED case manager, we have to consider that they’re very consistent with the roles and functions of an inpatient case manager, with a little bit of a twist on the theme. You might say that my inpatient case manager isn’t really a gatekeeper and doesn’t perform gatekeeping functions. But if you think about the role of the case manager in terms of patient flow and movement of the patient through the acute care episode — for example, on telemetry, off telemetry or in and out of the ICU — they really are gatekeeping the appropriateness of the movement of that patient through the acute care continuum. The same would apply to the ED case manager in that they are gatekeeping the patients that are being admitted to the hospital,” stated Cesta.