Case Management Flow Sheets

Managed care, multi-provider practices, and increased medicolegal regulation require thorough clinical documentation.  At the same time, the realities of business and reimbursement constraints necessitate that this documentation be as efficient as possible.

Case management flow sheets are an effective means of templating patient evaluation, care, and the procedural approach that a practitioner would ordinarily use in case management.  With a minimal amount of time, some consistent practice, and well-designed flow sheets, practitioners can maintain high-quality case management within the time constraints inherent in contemporary practice.

Flow sheets are case-at-a-glance documents that indicate the stage at which particular diagnostic, therapeutic, and evaluative services may be recommended.  Numerous advantages to this methodology include being able to map and monitor changes in the patient’s condition, thereby documenting the effectiveness of treatment. The documents lay out the major events in patients’ care on a visit-by-visit basis.  As procedures are performed, they are checked off to indicate completion.  This maximizes the efficacy of care delivery and ensures that necessary procedures are not inadvertently overlooked.

An advantage of case management flow sheets is that they serve as an ongoing reminder to include an entry for each dimension of the clinical management process. Abbreviations are essential, but must be standardized and used consistently by all clinic personnel.  It is essential to have a key of abbreviations used in the practice that can be referred to or supplied for third-party review.  Some jurisdictions even have laws or policies requiring this.

The selection of the appropriate case management flow sheet is based upon the application of the clinician’s choice of treatment protocol, based upon utilization guidelines, as applied to the patient’s specific condition. Physicians select and complete the appropriate flow sheet after a review of the patient’s evaluation and management findings upon the conclusion the initial office visit. The case management flow sheets I recommend are used in a reverse process.  This means that every procedure printed on the flow sheet is to be performed unless the physician considers it unnecessary and excludes it by striking through the procedure with a single line.

The application of utilization guidelines, treatment protocols and flow sheets to case management ensures that consistent, high-quality care is provided routinely and simplifies the assessment of patient progress and practice compliance.  Most importantly, it keeps your focus centered on your patients.

Dr. Mark Sanna is the CEO of Breakthrough Coaching, LLC, a leading resource for personal coaching to chiropractic and multi-disciplinary practices throughout the country.  He can be reached at Breakthrough Coaching, LLC, by calling 1-800-7-­ADVICE.

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