Building a strong nursing organization in a merged, service line structure.

In an increasingly complex healthcare environment, the discipline of nursing is difficult to define. Although a designated "department of nursing" may be absent on the organizational chart, the functional elements of the discipline remain. Nursing leaders will benefit from a framework to define and operationalize the core elements of nursing.

Case management of chronic ventilator patients. Reduce average length of stay and cost by half.

The implementation of the case management model and the use of critical pathways has become a major strategy to improve quality of care and cope with measuring and managing costs. Grant Medical Center, a 640-bed Level I Trauma Center, began case managing its chronic ventilator patients in July, 1993. A 30-day critical pathway was developed using a multidisciplinary team approach.

A systems approach to multidimensional critical paths.

Using a systems approach, critical pathways address different types of injuries in trauma patients. A 640-bed tertiary referral center contracted with an independent consultant to evaluate its trauma program, resulting in several improvements in the delivery of services. Case management achieved the action plan goals: improved utilization of resources, improved continuity of care, and decreased length of stay.