 Publication Date: 3/17/2026
Abstract
Effective case management and strong interdisciplinary communication are essential to reducing hospital length of stay, improving patient flow, and preventing avoidable readmissions. One strategy to support these goals is the use of a Discharge Complexity Score (DCS), a screening tool designed to identify patients who may experience barriers to safe and timely discharge. The DCS evaluates key factors such as medical complexity, social determinants of health, and anticipated post-discharge care needs. Early identification of complex discharges enables case managers and care teams to initiate proactive interventions and allocate resources more effectively. Hospitals are also increasingly utilizing Clinical Decision or Observation Units (CDUs) as a bridge between the Emergency Department (ED) and inpatient units. CDUs provide short-term monitoring and diagnostic evaluation—typically within 24 to 48 hours—to determine whether patients can be safely discharged or require inpatient admission. This model improves patient throughput and helps alleviate emergency department congestion during periods of high patient volume. When combined with structured communication tools, such as electronic hand-off systems, these approaches can further enhance care coordination. Electronic hand-offs ensure that critical patient information is transferred efficiently among providers. Together, discharge complexity screening, CDU care models, and improved communication strategies can strengthen care transitions, reduce length of stay, and decrease avoidable readmissions.
Learning Objectives
Comprehensive Program Development for Children with Medical Complexity within Primary Care
1. Describe why a coordinated approach to the needs of Children with Medical Complexities is crucial to the population’s outcomes and cost containment
2. Identify key features of a successful program addressing continuity of care for the CMC population
3. Summarize the process of continuous quality improvement as it relates to new program development
Clinical Decision Units: Their Role in Cost-Effective, Resource-Optimized Care
1. Establish how the Clinical Decision Unit functions with a dedicated staffing model.
2. Assess the benefits and challenges of the Clinical Decision Unit.
3. Demonstrate hospitalists and physician advisor workflow.
Speakers:
Maryanne DuBois Bourque, MHA, BSN, RN, CRCR, ACM RN
Maryanne DuBois Bourque, MHA, BSN, RN, CRCR, ACM RN is a healthcare leader with more than 35 years of experience in pediatric nursing. Her clinical background includes NICU, PICU, utilization review, and care and case management. She earned her Bachelor of Science in Nursing from Neumann University and a Master of Healthcare Administration from Saint Joseph’s University in Philadelphia. Currently, Ms. Bourque serves as Senior Director of Clinical Revenue Cycle. She is actively involved with the American Case Management Association and serves as Chair of the Pediatric Sub Committee for the National Conference.
Mandy Brady, SN, RN, MBA, CPN, CRCR, ACM RN
Mandy Brady, SN, RN, MBA, CPN, CRCR, ACM RN is a seasoned nursing leader with nearly 20 years of experience dedicated primarily to pediatric care. She has built a distinguished career grounded in clinical excellence, patient advocacy, and operational leadership. Over the past six years, Mandy has specialized in case management, where she has developed deep expertise in care coordination, utilization management, and improving patient outcomes across complex care settings. Mandy currently serves as the Manager of Case and Utilization Management, where she leads strategic initiatives to optimize care delivery, enhance departmental efficiency, and support high-quality, patient centered services. Her clinical background, combined with her business and leadership training, uniquely positions her to bridge clinical practice with organizational performance. She holds a Bachelor of Science in Nursing (BSN), a Master of Business Administration (MBA), and multiple professional certifications, including Certified Pediatric Nurse (CPN), Certified Revenue Cycle Representative (CRCR), and Accredited Case Manager (ACM RN). Mandy is committed to advancing the profession of case management and fostering collaborative, compassionate care for the patients and families she serves. She is currently obtaining her DNP from Widener University and expected to graduate in 2029.
Cristian Lemus Zavala, LCSW
Cristian Lemus Zavala, LCSW, serves as a Lead Complex Care Manager with seven years of experience in pediatric care coordination and care management. He holds dual bachelor’s degrees in Criminal Justice and Social Work from Bloomsburg University and a Master of Social Work from West Chester University. As a bilingual Spanish–English practitioner, Cristian specializes in supporting children and families with complex medical and social needs, with a strong commitment to advocacy and equitable access to care.
Anuradha Shunmugam Veluswamy, MD
Dr. Veluswamy is a dedicated Hospitalist Physician with nine years of experience in comprehensive inpatient care. As a board-certified physician, Dr. Veluswamy specializes in managing complex medical conditions, managing day-to-day care, and coordinating care with the specialists and the interdisciplinary team. As a Medical Director for Physician Advisors, Dr. Veluswamy serves as a liaison between Hospital leadership and clinical teams. She provides guidance on Utilization Management, Clinical Documentation Improvement, and compliance with health care regulations, contributing to measurable improvement in resource utilization and hospital efficiency. She also participates as a committee member for various improvement projects. Dr. Veluswamy advocates for patient-centered care, driving quality improvement initiatives, and mentoring emerging professionals. She holds a medical degree from P.D.U. Medical College, Rajkot, India, and completed residency in Internal Medicine at Montefiore Mount Vernon Hospital, New York. Additionally, she holds certification in CMPC, reflecting her commitment to professional development.
Keywords: Case management, discharge complexity score, clinical decision unit, care transitions, length of stay, discharge planning, interdisciplinary communication Collaborative Case Management Issue 100
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