What Is Discharge Planning and Utilization Review?
Discharge planning is critical to health care. It helps to transition patients from the hospital to home by collaborating with the physician, bedside nurses, specialists, and other members of the healthcare team. Discharge planners review not only the physical needs of the patient but psychosocial and financial needs as well. They work to remove barriers that may delay recovery or healing while at home. For patients who are still need continuing care, they arrange for admission to a skilled nursing facility, rehab facility, or assisted-living facilities.
Utilization review nurses work to examine the cost efficiency of healthcare services while maintaining quality of care. They review medical records to ensure patients are not undergoing unnecessary and costly tests or procedures and are not remaining needlessly in the hospital. They also help educate patients on their individual benefits plans, whether it is private insurance, Medicare, or Medicaid.
Both discharge planning and utilization review overlap with case management. Case management nurses, as with discharge planners, work collaboratively with the healthcare team to meet the needs of the patient. However, while discharge planners focus on the transition out of the hospital, case managers focus on the entire stay as well as out in the community. Additionally, case managers also perform utilization review, ensuring patients are not over-utilizing resources unnecessarily while receiving the care they need.
Essentially, "case management" is an umbrella term that incorporates both discharge planning and utilization review. While they are different titles, can overlap based on the needs of the patient.
RELATED: See our overview of case management within the NCLEX-RN exam.