The unit manager is reviewing documentation describing a client's progress in terms of a critical path (Care Map) for postoperative colon resection recovery
The manager notes that, although the documentation is complete, the client has made minimal progress in the areas of mobility and pain control for the prior 48 hours. The manager's first activity after making the observation of deviation from the path is to contact the client's: 1. Family to determine what is wrong
2. Assigned nurse to increase client care interventions
3. Physician to determine measures to discharge the client
4. Case manager to determine whether the predicted variance has been negotiated with the health insurer
4
Rationale: "Case manager to determine whether the predicted variance has been negotiated with the health insurer" is correct because the unit manager is accountable for cost recovery. In this situation, documentation is complete; however, each client's progress along the critical path can vary. "Assigned nurse to increase client care interventions" is incorrect because there is no indi-cation that the care is ineffective. There is no need to contact the physician ("physician to deter-mine measures to discharge the client") or the family ("family to determine what is wrong") be-cause the subject is cost recovery. The manager works to be certain that the costs incurred will be negotiated with the insurer at the time that the variance is detected and that the hospital is paid for the costs of providing care longer than the time period defined by the critical path.
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