Beena is a director of case management. She directs her staff to support the physicians and interdisciplinary team to promote quality cost effective care. She instructed staff using communications and available resources in coordinating care to meet patients comprehensive health needs.

Beena is always available and willing to assist patients, her staff, and interdisciplinary teams in discharge planning and providing resources. When needed, she will be present to solve challenging cases to bring the best possible outcome. Below is one of many d/c challenging cases that Beena had involved to solve it.

L presented to the hospital with complaining of fall from her wheelchair and lower extremities injury. She is paraplegic and wheelchair bound for the past few years at home. She lives at home with family care prior to hospitalization. She was admitted to the Joint Center, then was transferred to ICU due to respiratory distress and was intubated. She then extubated and transferred out of ICU. On the 8th day of her hospitalization, while the patient was in ICU, case management team had discussed discharge planning with patient, family, physicians, and interdisciplinary team. They were in agreement that SNF (skills nursing facility) was as appropriate for post-acute discharge disposition at this time. However, per patient's daughter request, LTACH (long term acute care hospital) referral was made, even though upon clinical review, patient's severity of illness and level of care did not meet LTACH admission requirement. Patient transferred out of ICU to medical surgical floor on Tuesday.

On Wednesday, at length of stay (LOS) meeting, the case was presented. Beena called her and spoke with the insurance medical director to inquire whether or not the insurance would give authorization for LTACH placement for this patient; the insurance medical director said no (routinely if awaiting for official denial for the insurance that will take up to 72 hours). Beena instructed to start SNF evaluation for this patient. After discussed at length with patient and family, they agreed to look into SNF list. SNF referral was initiated on Thursday afternoon once patient provided the SNF choice; with the acknowledgment of the insurance routine approval for post-acute placement process (take up to 72 hours to respond) and the weekend approaching. Beena instructed the case manager to call the insurance to expedite the approval process. The SNF authorization was given by the insurance on Thursday evening.

Patient and family were informed of SNF approval and LTACH denial by the insurance. Patient's family wanted to appeal the insurance decision. Information provided to patient and family for the appeal process. On Friday morning, nursing informed case manager that L's daughter was very upset. She stated that L is not getting quality care that she needed. Her health has gotten worse since she admitted to the hospital. The patient's daughter stated that her mother was not medically ready to be discharged to SNF; she wanted her mother to stay in the hospital for a few more days. The issue reported to patient relations and unit manager who presented to patients room and allowed her daughter to voice her concern. The issue was reported to Beena for her assistance. After collecting all necessary information about the patient's situation, Beena had called the attending and all consult to learn more about their recommendations. They all recommended that the patient cleared to be discharged to SNF for continuing of care. Then Beena visited patient and family to allow them to voice their concern and request.

At length, patient's daughter stated that she did not agree with discharging her mother to SNF at this time. She wanted her mother to stay in acute care hospital for a few more days. Beena informed patient's daughter that she had discussed with all physicians who took care of her mother and they recommended SNF for appropriate post-acute disposition of her mother at this time. Beena also informed patient's daughter that she spoke with the SNF's director to make all necessary arrangement to help her mother transition of care as smoothly as possible. Patient's daughter insisted that she did not want her mother to be discharged from an acute care hospital to SNF at this time. She requested that all physicians to come evaluate her mother and speak with her in person about their recommendation regarding her mother post-acute care discharge deposition. Beena again called L's physicians to inform them of the d/c issue and asked them to come to see the patient and her family per their wishes. Per Beena request, an orthopedic, an intensivist, and a pulmonologist came to see patient and her family within an hour.

The physicians informed patient and daughter that SNF is an appropriate post-acute d/c disposition for the patient and that the patient is cleared to be d/c from the hospital. Beena then returns to the patient's room. The Patient and family now agreed to be d/c to SNF; however, patient's daughter requested for her mother to be d/c on Saturday instead of Friday. Beena informed her that the decision will be made by the attending physician. Beena also advised her of the advantage of transitional care on the weekday instead of weekend. Besides, Beena spoke with the SNF director regarding the patient's medical issues and needs, including arranging Bipap machine for her on admission to SNF. Once all patient and her family's issues and needs have been addressed and resolved, patient's daughter agreed to have her mother d/c to SNF that day. Beena called the attending to report to him the d/c planning and that she needs to come and see the patient and enter discharge order. All the issues were resolved by noon. The patient, her family, physicians, and staff (nursing) were satisfied. The patient was d/c to SNF by 3pm on Friday.

The situation above is one of many cases that Beena has done or instructed her staff to do on a daily basis. Beena always get the job done with compassion, caring, and positive attitude. Beena is not only working towards the best possible clinical outcome for the patient, but she is also taking care of all staff who works for her when the department is in crisis. Beena took the most challenging work load to herself.

Beena is an extraordinary RN case management director who always goes above and beyond to get the job done. Her consistent diligence and hard work bring the best possible outcome to the hospital throughput, finance, and patient satisfaction. Her knowledge and effective communication help to d/c patient to an appropriate and safe disposition in a timely manner which opens up an acute care hospital bed to serve a patient whom the severity of illness would need the intensity treatment of the acute hospital level of care.

Beena's role is the most challenging area in nursing practice. She tackles it with enthusiasm, compassion, and caring attitude. She is working side by side with her peers.

I nominate Beena for the DAISY Award for her great contribution to the positive patient experience/satisfaction at Memorial Hermann Greater Heights.