I never thought in my current position that I would need to pull from the archives the skills involved with catastrophic cases, but I was faced with this task suddenly with Richard. Richard had just started a new job. He was less than two weeks into his training when the unimaginable happened. His right hand became caught in a conveyor belt and he suffered a severe degloving injury. This required immediate hospitalization, emergent surgery and multiple debridement surgeries within the first week. I got the call from my supervisor with notification of this injury late on a Sunday afternoon of a holiday weekend and was visiting Richard in the hospital Monday morning for my initial assessment. This onsite visit was rare in my current position, but I was thrilled as I had a catastrophic case!
I leapt into action. It was like a switch turned on in my brain and I instinctively knew what to do. While at the hospital, I met with Richard and his family, explained my role as a case manager and assured them that I would be with him every step of the way. This was his first workers’ compensation injury. I conferred with the hospital case manager anticipating every possibility for his discharge plan. Later in the week, I was notified that discharge was indeed planned for Saturday. I worked with the physician’s office in assuring appropriate actions for billing and reimbursement, as they were not yet enrolled providers for federal workers’ compensation. I assisted the family on Saturday, the day of discharge from the hospital.
After discharge, the physician recommended Maggot Therapy as the wound and graft were not healing appropriately. At this point I felt it crucial to request a field nurse case manager as the treatment options were becoming complicated. The assistance the field nurse could provide with expedited authorizations and the possible long-term complication of amputation were staring me in the face. Through the efforts of headquarters, a field nurse case manager was assigned immediately. I shared my nursing assessment and plan thus far and then placed my file on hold.
Over the next several weeks, Richard improved and underwent final grafting surgery. He returned to limited duty in 37 days and regular duty in 67 days post injury. Incredible!
What makes me a proud case manager to have been involved in this case was not only the impact I had in expediting the medical and billing arrangements, but the team’s response and actions to this catastrophic injury. His co-workers exemplified a quick response in providing immediate first aid to Richard’s gushing wound. The EMS response time was less than two minutes in transporting him to the emergency room. The employer provided immediate notification of the injury to the nurse case manager. Finally, the fantastic trauma plastic surgeon who delivered impeccable care to this 21-year-old young man. I think we all saved Richard’s hand, and I am proud to have been a part of the success.
