Case Management: Interview with Leila Esmaili, RN, MSN
Coordinating a plan for care for patients
Leila Esmaili, RN, MSN
Case Management Lead and Educator
Glendale Adventist Medical Center
How did you begin your case management career?
I’ve been a nurse for 16 years. I’ve done bedside nursing at many different levels of care in various settings and I enjoy every aspect of nursing. I became interested in case management during graduate school while working on a project with the case management department at Glendale Adventist. The director of case management provided me with excellent guidance, education and mentoring. That invaluable experience led me towards my current career.
What was the focus of your master’s degree?
I earned a master of science in nursing degree with a focus on nursing education and administration.
Are you able to mentor students in your current role?
Yes, I’m now a preceptor for many master’s-level students. I was skillfully mentored and now I try to mentor others in the same way.
With the aging population and more people aging in place at home, how has the role of the case manager changed?
With changes in the aging population and the insurance plans that cover them, we’re really like a task force that finds ways to connect patients with the resources they need to prevent illness and hospitalization.
We work with grant-based community organizations that help keep patients at home and out of the hospital. That includes identifying and addressing the issues that prevent patients from following up with their doctors.
Working closely with our hospital’s transitional care team, we work to lower readmission rates for diagnoses such as PNA [pulmonary nodular amyloidosis], CHF [congestive heart failure], COPD [chronic obstructive pulmonary disease], ESRD [end-stage kidney disease] and AMI [acute myocardial infarction].
We ensure that discharge instructions and medication reconciliation are sufficient and accurate and we connect patients with the post-discharge team for follow-up appointments with outpatient physicians and specialists.
Connecting our aging population with home health services is important since this allows those patients to receive services that assist them in maintaining independence and preventing hospitalization. Our collaborative efforts have made a difference. For example, our records show that our CHF readmission rates have significantly decreased.
What happens in communities where there isn’t such support for patients?
In those communities, there isn’t necessarily any follow-up and there may be problems with frequent readmissions. Hospitals in communities without that level of outpatient services focus on educating the patient and the family during hospitalization, connecting them as best they can with whatever resources are available.
Are there special trainings or certifications recommended or required for case managers?
Most hospitals don’t require their case managers to have master’s degrees, but many facilities prefer them to earn the designation of CCM (certified case manager).
What brings you joy in the course of your work?
What I love about Glendale Adventist is the unique culture of professionalism. I love that the administration sets high standards and expects the best from everyone! The high levels of technology, expertise, passion and teamwork are also factors that make me love my workplace.
In terms of case management, I really like how much I learn from day to day. My mind is fully engaged and there are always new things to learn and patients to educate. Bringing valuable resources to patients is very satisfying and I enjoy learning about new conditions, new treatments, new procedures, and the ways that healthcare delivery and health plans are changing.
Case management is never routine and I expect to learn something new every day. I’ll be working another 30 years before I retire and I just want to keep learning and growing.
What are some of the challenges of your work?
Currently, the major challenges we’re facing are the new healthcare benefits and resources that are in the process of change, which impact both the hospital and our patients. In the long term, prevention and health promotion will become the focus, but we aren’t quite there yet.
Another issue is the types of services and care that aren’t covered by insurance. For instance, if your health plan won’t pay for you to see a weight loss specialist, this can lead to preventable complications with your diabetes as well as unnecessary hospital admissions.
An example would be a situation in which a patient needs to be discharged to a nursing home that refuses to pay for the medication that the patient requires. This oral medication may cost as much as $160 per dose and most skilled nursing facilities, home health agencies and insurers will not take on the cost of such a treatment. So, the patient has to remain in the hospital longer in order to receive the medication, which impacts our length-of-stay statistics and the overall cost of the patient’s hospital care.
Do you have any advice for nurses interested in case management?
For those bedside nurses, I say that case management is not necessarily what they think it is. We don’t just work at a computer all day. Case managers need to be critical thinkers who are capable of planning, evaluating, thinking ahead and communicating clearly with patients, doctors and colleagues as well as with other providers, agencies and facilities.
If nurses want to transition to case management, they need to think about who they are and what skills they have to offer. You have to be emotionally strong, resourceful and a critical thinker who is willing to deal with the rapid changes in healthcare that will continue to occur.
Keith Carlson, RN, BSN,CPC, NC-BC, has worked as a nurse since 1996 and has maintained the popular nursing blog Digital Doorway since 2005. He offers expert professional coaching for nurses and nursing students at www.nursekeith.com.
This article is from workingnurse.com.