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Case Management and the Documentation of Avoidable Days

Shelerud, Leah N. MSN, RN, CCM, CRRN,; Esden, Jana L. DNP, APNP, FNP-BC

doi: 10.1097/NCM.0000000000000194

Purpose of Study: Avoidable Days/Delays (ADs) account for a large portion of dollars lost for many health care organizations, and with ongoing changes in health care reimbursement, available funds will become increasingly limited. Avoidable Days cannot be reduced or eliminated without accurate causal documentation. The purpose of this study was to determine whether a system upgrade with a change in documentation layout for AD tracking increased case manager compliance with AD documentation. In addition, staff perceptions and opinions on AD documentation were obtained to determine whether or not these perceptions could affect accurate documentation of ADs.

Primary Practice Setting: A large academic medical center.

Methodology And Sample: Quantitative data were gathered through a survey completed by the hospital's case managers, and raw data were obtained from the electronic health record system on the number of documented ADs before and after the system upgrade.

Results: The results indicated that the system upgrade did improve case manager documentation of ADs. Survey results suggested that more education was needed on ADs, including information on financial impact, importance of accurate documentation, and plans for performance improvement initiatives for frequently documented AD causes.

Implications for Case Management Practice: The majority of surveyed case managers felt that they would benefit from increased education on AD documentation. Recommendations for case management practice include (1) incorporating AD education into the orientation curriculum for new case managers, (2) readdressing the importance of AD documentation in case managers' annual review education, and (3) extending AD education to additional hospital staff to make AD tracking an organizational commitment.

Leah N. Shelerud, MSN, RN, CCM, CRRN, is an Outcomes Manager at University Hospital in Madison, WI. She graduated with her BSN from Carroll College in 2005 and with her MSN from Edgewood College in 2016. She has been a case manager for 5 years, and her interests include accurate avoidable day documentation and complex medical care.

Jana L. Esden, DNP, APNP, FNP-BC, is a Family Nurse Practitioner and an Assistant Professor at Frontier Nursing University, Hyden, KY. Her current research interests include chronic care, underserved populations, and adverse childhood experiences. In her clinical role, she works with a community clinic to serve patients at a transitional housing complex in Northeast Wisconsin.

Address correspondence to Jana L. Esden, DNP, APNP, FNP-BC, Frontier Nursing University, 195 School Street, Hyden, KY 41749 (

The authors report no conflicts of interest.

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