When you get those new cases on your desk, how do you determine if there is a case worth pursuing there?

Merit Reviews

When you are doing an initial case review,  you look for possible breaches of care that occurred and want a concise description of those breaches. You are also looking for negatives of the case. For instance, documentation noting a resident or patient to be non-compliant or combative; or if  pressure wound development began in another facility.

Also important in these initial reviews is whether any breaches of care outweigh the negatives of the case or vice versa. For instance, if the facility did not do appropriate interventions to prevent presser ulcer development, a resident’s end stage renal disease may create too difficult a question of causation to proceed.

When initially looking at case records, you need and honest and open opinion about the case to note if the negatives outweigh the merits of the case or if the case appears as a strong one.

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