Substitution of hospital staff in concurrent utilization review.
Substitution of hospital staff performing concurrent utilization review (CUR) was evaluated using a production process framework. There were no differences in the number of reimbursement denials or denied days among 4 job classifications of hospital staff performing CUR, indicating that educational preparation of staff did not affect outcomes. The implications are that hospitals could substitute assistive staff in place of registered nurses to complete the CUR function, potentially increasing the availability of professional nurses.
Darmody
Julie
J
Clinical Science Center, School of Nursing, University of Wisconsin-Madison, Madison, WI 53792, USA. jvdarmody@wisc.edu
Pawlak
Roberta
R
Hook
Mary
M
Semeniuk
Yulia
Y
Westphal
Judith
J
Murray
Mary Ellen
ME
Henriques
Jeffrey
J
D000046:Academic Medical Centers; D000704:Analysis of Variance; D019090:Case Management / Q000458:organization & administration*; D016009:Chi-Square Distribution; D003211:Concurrent Review / Q000458:organization & administration*; D004496:Education, Continuing; D004500:Education, Graduate; D006801:Humans; D007345:Insurance Claim Review / Q000706:statistics & numerical data; D015146:Midwestern United States; D015403:Nursing Evaluation Research; D009741:Nursing Staff, Hospital / Q000193:education / Q000458:organization & administration*; D010043:Outcome and Process Assessment, Health Care; D011361:Professional Competence / Q000592:standards; D024382:Professional Role; D015397:Program Evaluation; D012189:Retrospective Studies; D012456:Salaries and Fringe Benefits; D012947:Social Work / Q000193:education / Q000458:organization & administration*