Date of Graduation

Summer 8-4-2024

Document Access

Project/Capstone - Global access

Degree Name

Master of Science in Nursing (MSN)

College/School

School of Nursing and Health Professions

Program

Kaiser cohort MSN capstone

Abstract

Problem: The utilization management department at Santa Clara Medical Center had low compliance with InterQual criteria, at 35%. This resulted in inconsistent care decisions, poor resource allocation, and regulatory penalties, affecting patient care and performance.

Context: The project aimed to enhance InterQual utilization, aligning with Santa Clara Medical Center's goals of evidence-based, patient-centered care. The initiative was guided by Jesuit values and ANA ethical standards, focusing on service, justice, excellence, patient advocacy, and professional responsibility.

Interventions: The project implemented three main interventions: comprehensive training programs, regular audits, and performance recognition. These interventions aimed to address gaps and ensure the effective use of InterQual criteria in patient care decisions.

Measures: Effectiveness was measured using several metrics: the percentage increase in InterQual utilization, the number of case managers completing InterQual training, the number of cases using InterQual criteria, and feedback on InterQual usability.

Results: Compliance rates increased from 35% at baseline to 81% by Week 8, demonstrating the effectiveness of the training programs, audits, and performance recognition.

Conclusions: The project significantly improved InterQual utilization, resulting in more consistent and evidence-based care decisions. Sustaining these improvements will involve ongoing training, regular audits, and performance recognition. There is a high potential for these interventions to be applied in other departments and institutions.

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