Improving Utilization of InterQual among Case Managers/Patient Care Coordinators at Santa Clara Medical Center

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.