Nurse Case Manager Chronicles

Making the Connection

Quick-thinking nurse case managers helped solve a medical mystery and facilitated treatment that saved a man’s life.
By: | November 1, 2017 • 5 min read

Although it’s rare, there are times when a seemingly simple injury can turn catastrophic in the blink of an eye. When it happens, nurse case managers can find themselves in a race against the clock, with a worker’s life hanging in the balance.

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Delainne Bond and her colleague found themselves in exactly that position when a scratch almost became the cause of a workplace fatality.

A worker lost his grip and fell when riding on the back of a truck. The truck was going less than 10 miles per hour and the fall was around four feet. The worker incurred a small scratch on his cheek and a chipped tooth — nothing that would be considered severe. The man was treated at an urgent care facility.

“This worker didn’t work in what we would call a ‘medically clean’ environment,” explained Bond, a registered nurse and certified case manager. So the medical professionals on staff gave him an antibiotic to prevent any infection from the scratch. They told him to follow up with his dentist about the chipped tooth.

Overnight, the worker’s face and body broke out in a rash. He went to the hospital, but after seven and a half hours of waiting, he left without medical attention. The next day, he followed up with urgent care, where he learned he should be admitted to the hospital.

Delainne Bond, national catastrophic program manager and national crisis intervention coordinator, Genex Services

Unfortunately, the worker didn’t think the rash was as bad as the doctors said and insisted on going home. By day five, the rash took a grim turn, bordering on catastrophe.

“He was super sick. He went to a local community hospital, one that didn’t have a lot of resources,” said Bond, who has 11 years’ experience working in case managing. She is the national catastrophic program manager and the national crisis intervention coordinator at Genex Services, which specializes in medical management.

“They got him on an IV, but the staff was unsure of what was going on with him.”

One of Bond’s nurse case managers was there. Even without knowing the exact diagnosis, she knew the man wasn’t receiving the proper care for his illness.

Using her network of medical professionals, said Bond, the nurse contacted the right doctor for the job. He came in and assessed the situation. He confirmed that the rash was a rare reaction — called Stevens-Johnson Syndrome — to the antibiotic the patient took.

“You don’t come into this job and expect to be saving peoples’ lives, but it happens.” — Delainne Bond, national catastrophic program manager and national crisis intervention coordinator, Genex Services

Stevens-Johnson Syndrome is a serious skin disorder that oftentimes begins with flu-like symptoms followed by a painful reddish-purple rash that spreads and blisters.

The injured worker needed to see a burn specialist, the doctor concluded. The rash blistered into his mouth, lining his digestive tract and had spread across his body and face. He no longer talked, ate or used the restroom without assistance. He faced a 70 percent mortality risk.

“By comparison,” Bond said, “hospitals consider three percent mortality risk to be unacceptable.”

Now, Bond was on the job. No stranger to intense scenarios, she oversees some of the “worst-case” injuries employees face. Amputees, motor vehicle accidents, burn cases and the like are escalated to her.

She met with the employer, carrier, lawyers and company executives to explain the severity of the situation. Those present unanimously agreed to air-lift the patient from the local hospital to a burn facility.

“A hospital-to-hospital transfer can take one to two days, or even more, to obtain authorizations and contracts with the air-lift and ambulance agencies and establish doctor-to-doctor communication,” explained Bond. Her team moved the worker within four hours.

Finally connected with the right level of care, the man made an instantaneous recovery. He was discharged 36 hours after being transferred.

Crisis Care Saves Lives, and More

“If we didn’t have that case manager on site, if she hadn’t had analyzed him and knew to bring me onto the case, and if I didn’t know where the right resources were … ” Bond began. “You don’t come into this job and expect to be saving peoples’ lives, but it happens.”

Bond’s depth of experience allows her to spot issues that might otherwise be overlooked. Clients rely on her ability to glance at a file and know what to do and what resources to tap into.

In another case that Bond worked on, a truck driver broke his neck and skull during an accident. After a few days in the hospital, the man slipped into a coma. The hospital staff thought it was related to his brain injury, but upon reviewing his chart, Bond determined it was a diabetes crisis issue.

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The truck driver received insulin, and the case manager proved that the diabetic crisis caused the accident, saving the employer’s insurance roughly $175,000 in medical bills.

“The biggest challenge is getting in there and making everybody feel like it’s going to be okay,” Bond said. “The injured worker is feeling panic. The employer is facing their own pressures, like keeping their workforce on task, while dealing with OSHA. Carriers have to analyze the injury, make sure it’s compensable. For people coming from a non-medical background, it’s easy for them to not know what’s going on.”

This is when a case manager steps in, calming the patient, setting up proper appointments and explaining the situation to employers and carriers.

“A lot of employers, and even a lot of nurses, don’t really know what case management is or what it entails,” said Bond. “Every day is new. Every case is unique. I’m still learning new things even after all these years.”

The case manager role removes barriers that might be in the way of recovery — a position that Bond said can be just as rewarding as it is challenging.

“I want to see the profession utilized more,” she said. “Case managers are very effective in minimizing injury and reducing risk.” &

Autumn Heisler is a staff writer at Risk & Insurance. She can be reached at [email protected]

More from Risk & Insurance

More from Risk & Insurance

2017 Teddy Awards

The Era of Engagement

The very best workers’ compensation programs are the ones where workers aren’t just the subject of the program, they’re a part of it.
By: | November 1, 2017 • 5 min read

Employee engagement, employee advocacy, employee participation — these are common threads running through the programs we honor this year in the 2017 Theodore Roosevelt Workers’ Compensation and Disability Management Awards, sponsored by PMA Companies.

A panel of judges — including workers’ comp executives who actively engage their own employees — selected this year’s winners on the basis of performance, sustainability, innovation and teamwork. The winners hail from different industries and regions, but all make people part of the solution to unique challenges.

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Valley Health System is all-too keenly aware of the risk of violence in health care settings, running the gamut from disruptive patients to grieving, overwrought family members to mentally unstable active shooters.

Valley Health employs a proactive and comprehensive plan to respond to violent scenarios, involving its Code Atlas Team — 50 members of the clinical staff and security departments who undergo specialized training. Valley Health drills regularly, including intense annual active shooter drills that involve participation from local law enforcement.

The drills are unnerving for many, but the program is making a difference — the health system cut its workplace violence injuries in half in the course of just one year.

“We’re looking at patient safety and employee safety like never before,” said Barbara Schultz, director of employee health and wellness.

At Rochester Regional Health’s five hospitals and six long-term care facilities, a key loss driver was slips and falls. The system’s mandatory safety shoe program saw only moderate take-up, but the reason wasn’t clear.

Rather than force managers to write up non-compliant employees, senior manager of workers’ compensation and employee safety Monica Manske got proactive, using a survey as well as one-on-one communication to suss out the obstacles. After making changes based on the feedback, shoe compliance shot up from 35 percent to 85 percent, contributing to a 42 percent reduction in lost-time claims and a 46 percent reduction in injuries.

For the shoe program, as well as every RRH safety initiative, Manske’s team takes the same approach: engaging employees to teach and encourage safe behaviors rather than punishing them for lapses.

For some of this year’s Teddy winners, success was born of the company’s willingness to make dramatic program changes.

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Delta Air Lines made two ambitious program changes since 2013. First it adopted an employee advocacy model for its disability and leave of absence programs. After tasting success, the company transitioned all lines including workers’ compensation to an integrated absence management program bundled under a single TPA.

While skeptics assume “employee advocacy” means more claims and higher costs, Delta answers with a reality that’s quite the opposite. A year after the transition, Delta reduced open claims from 3,479 to 1,367, with its total incurred amount decreased by $50.1 million — head and shoulders above its projected goals.

For the Massachusetts Port Authority, change meant ending the era of having a self-administered program and partnering with a TPA. It also meant switching from a guaranteed cost program to a self-insured program for a significant segment of its workforce.

Massport’s results make a great argument for embracing change: The organization saved $21 million over the past six years. Freeing up resources allowed Massport to increase focus on safety as well as medical management and chopped its medical costs per claim in half — even while allowing employees to choose their own health care providers.

Risk & Insurance® congratulates the 2017 Teddy Award winners and holds them in high esteem for their tireless commitment to a safe workforce that’s fully engaged in its own care. &

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More coverage of the 2017 Teddy Award Winners and Honorable Mentions:

Advocacy Takes Off: At Delta Air Lines, putting employees first is the right thing to do, for employees and employer alike.

 

Proactive Approach to Employee SafetyThe Valley Health System shifted its philosophy on workers’ compensation, putting employee and patient safety at the forefront.

 

Getting It Right: Better coordination of workers’ compensation risk management spelled success for the Massachusetts Port Authority.

 

Carrots: Not SticksAt Rochester Regional Health, the workers’ comp and safety team champion employee engagement and positive reinforcement.

 

Fit for Duty: Recognizing parallels between athletes and public safety officials, the city of Denver made tailored fitness training part of its safety plan.

 

Triage, Transparency and TeamworkWhen the City of Surprise, Ariz. got proactive about reining in its claims, it also took steps to get employees engaged in making things better for everyone.

A Lesson in Leadership: Shared responsibility, data analysis and a commitment to employees are the hallmarks of Benco Dental’s workers’ comp program.

 

Michelle Kerr is associate editor of Risk & Insurance. She can be reached at [email protected]