Skip to main content

Babysitting With a Purpose

In the 20+ years I've been a case manager, I've certainly seen employers grow to embrace the idea and benefit of light duty work.  In the 1990's the Safety Director at one factory used to say "if the employee can't lift more than 10-lbs., they can't open our door to get in - We don't have room to babysit!"   Staff changes have come and gone several times since then, and the mindset of the company has totally changed now to one of accommodating pretty much any restriction in order to avoid lost time as long as it is in the best interest of the injured worker. 


Right now, Kelli Wells, RN has an injury case with that same company that demonstrates how light duty can benefit everyone involved.  The injured worker sustained a bump to his shin that he didn't think was significant.  Within a week, it became apparent the resulting wound was not healing adequately, and the IW was referred to a general practitioner, who recommended referral to a wound specialist.    This is where Case Management referral was received.

Kelli assessed some potential barriers to healing:  obesity (300-lbs), use of smokeless tobacco, and untreated hypertension.  Soon, the barrier of noncompliance would come into play - continued nicotine use (impedes vascular bloodflow), scratching/picking at the wound (bacteria introduction), taking his meds inconsistently, removing bandages prematurely, etc. - Kelli has had her hands full.  But he was still working regular duty!  

After six weeks with the wound specialist, healing progress was still very slow, and the MD recommended IW to keep his legs elevated for all but 1-2 hours per day.  Many times this would indicate an "off work" status, however his employer was concerned about noncompliance (ya think?) with restrictions at home.  After a team conference, Kelli was able to negotiate a LD RTW with 9 of 10 hours keeping the leg elevated above the heart.  That would never have happened if there'd not been a case manager on the file, or if there'd not been an employer willing to "babysit" an employee for 9 out of 10 hours to assure compliance for a large part of the day.  

Now two weeks later, the wound appears significantly improved, indicating the treatment plan is on track.  Work restrictions have been relaxed a bit, to allow more activity.   What's the value of the case manager? The employer is benefiting by avoiding lost time, the injured worker is benefiting by healing and progress toward return to normal activities; and the carrier is benefiting from lower expenditures (no TTD, shortening length of treatment, and decreased treatment needs).  All from babysitting.  I guess we're never too old to babysit - or have a babysitter!
Labels:

Comments

Post a Comment

Popular posts from this blog

At the Heart of Case Management

I have done presentations on The Benefits of Case Management to carriers, peers, and other health care professionals.  Sometimes it sounds dry and philosophical to list benefits: access to care, best practice recovery, lowered cost expenditures. But who is the one that benefits?  In our practice, is it the injured worker? the employer? the insurance carrier? From the Case Management Society of America, "It is the philosophy of case management that when health care is appropriately and efficiently provided, all parties benefit." Allow me to demonstrate for you the heart of case management from two of our case managers this week. One of our CM Team has a patient that was "swimming" amidst a work injury and numerous mis-diagnoses and was fearful this CM's job was to just "write him off." Our RN worked to find a physician that would clarify his diagnoses, even collaborating between his group health carrier and Work Comp carrier.  At the conclusion of a...
Post a Comment
Read more

The Head Bone's Connected to the Neck Bone...

My first test in college anatomy we were given a piece of paper with numbered lines, 1-206.  Instructions were simple:  Name the 206 bones in the body.  I made 100% - thank you. Learning anatomy of all the body systems, and the physiology of how they interact is my love in the medical field.  The science of it all fascinates me. There is a logical physiologic reaction to bodily injury, and a RN Case Manager's critical thinking skills help anticipate symptoms and complaints.   If you hit your thumb hard with a hammer, we know you will have pain, and probably stiffness; and if you smashed it good enough, you could have "sympathetic" stiffness of adjoining fingers in the hand.  That is a known physiologic response. Stacy Mathis, RN has a patient with multiple injuries has begun to relate all aches and pains to his MVA.  The problem is, not all his complaints can be physiologically connected to the injury.  This is quite common in catastrop...
Post a Comment
Read more

Case Management GPS

W The next time I purchase a new vehicle there are several features I have on my wish list.  For as much as we case managers travel, Navigation is high on the priority scale to make life easier.  Under the pressure of arriving at a physician appointment on time, it's never a good feeling to take a wrong turn or get lost. There are times our role as a case manager is much like a navigator. Deana Scott, RN had that experience just yesterday while attending a physician visit.  After three years of treatment for a work injury, the physician had nothing further to offer, and there appeared to be issues of malingering and symptom magnification.  There was a point at which the physician actually had a look in his eye of being lost as  far as how to bring the treatment course to an end.  Confusion centered around  the injured worker's return to work goals.   It's at times like this, a Case Manager is able to maintain focus and much like a navigato...
1 comment
Read more