Converting case managers from MD/service to unit-based assignments: a before and after comparison.

An ongoing dilemma in acute care case management is whether to assign case managers to a unit or MD/Service-based assignment. There are strong logical arguments to be made on both sides of the decision. There are also strong political reasons why organizations opt for one or the other. This article describes one hospital's rationale and experience in converting from care manager assignments made on the basis of partnering with the MDs/Service, to serving both the point of care nursing unit and the physicians. Of note, the unit-based assignment structure has (1) saved 90 min a day in each care manager's time; (2) allowed care managers to help nursing better plan, pace, and trace care; (3) helped the hospital accommodate a 9% increase in admissions with an additional 140 more referrals to the Transitional Care Unit; and (4) ensured the consistent management of the observation level of care.