SDN Members don't see this ad. (About Ads) This question is directed more towards those in post-residency life. I'm the ED Medical Director of a busy suburban ED (50K visits). Our hospital has hired a new Director of Case Management who has an entirely new approach to ED case management. While the old Case Manager would sit side by side with us in the ED, and request better documentation to justify an admission or admission vs. obs decision, the new lady has blocked several admissions because they "don't meet criteria". Case 1 was a lady with new, severe hemorrhoids that couldn't poop, obs for pain control and surgery c/s. Case 2 was a schizophrenic off meds, on her period, with an asymptomatic anemia (Hgb 7.5). Psych facility wouldn't take her without a transfusion, so obs for transfusion and psych dispo. Case 3 was similar to 2 (psych vs organic, obs for drugs to wear off and psych eval) All three stayed in the ED for hours (up to 24), and 1 and 2 were eventually admitted after the Case Manager's meddling plans fell through. I have a meeting with her and my ED leadership team next week. Are there any laws/rules which I could use to stop this practice? I'm all for a collegial discussion and adding documentation to support an admission or level of care decision, but as you can imagine blocking my docs' admissions doesn't go over very well with me or the nurses.