Planning for Safe Patient Discharges

Podcast Transcript

Carol Pehotsky: As a bedside nurse we often have to be so focused on the care of our patients in the moment, assessing what their needs are and prioritizing interventions that are targeted to those needs. Fortunately for our patients, the moment that that patient arrives, there are other caregivers that are working in parallel focusing on what support and resources those patients need to be successful outside of the hospital.

We're joined today by Mark Torok, Senior Nursing Director of Care Management, to talk about this vital nursing specialty and the role it plays in the care of our patients.

Hi, and welcome to Nurse Essentials, a Cleveland Clinic podcast where we discuss all things nursing from patient care to advancing your career, to navigating tough on the job issues. We're so glad you're here. I'm your host, Carol Pehotsky, Associate Chief Nursing Officer of Surgical Services Nursing.

Welcome back everyone. Even way back from when I was first in nursing school, which if you've been listening for a while, you know, is many, many years ago. But even then, we were already being taught the adage of discharge begins at admissions for those who were looking to go into inpatient nursing in any form or fashion is knowing that patients come to us very vulnerable. We can't wait till the end to start talking about that.

But goodness sake, that was 2004. And looking at the healthcare landscape then, and how challenging it could be to ensure those patients had the right resources to take care of themselves, to be in a good stead and also to avoid readmission was hard enough then.

And we fast forward now 21 years and the landscape is just that more complex. There're for sure more potentially resources in theory, but how do we connect patients to them? How do we, whether we're an inpatient nurse or anywhere along the spectrum, be thinking about, you know, if a patient ends up in an, in an inpatient facility, how do we help them get to that next stage of care, what they're looking for and what's right for them?

So with that's my great pleasure to welcome Mark Torok today. Mark is a senior nursing director for Inpatient Care Management. Mark, welcome.

Mark Torok: Thank you, Carol.

Carol Pehotsky: Thank you so much for joining us today. So. This is your wheelhouse. We're so glad to have you here.

Mark Torok: Awesome.

Carol Pehotsky: So, um, appreciating that you've had quite the journey in your career thus far, do you mind kicking us off by going through your career thus far and what you've learned along the way?

Mark Torok: Yeah, of course. First off, thank you for having me. It's super exciting to highlight care management. [Yeah.] So I'm super privileged to discuss our caregivers and our awesome departments. So. Thank you for that.

So some of my background, I went to Kent State University.

Carol Pehotsky: Hey, golden Flashes. All right.

Mark Torok: Yeah. Very well prepared. So great school.

My first job outta nursing school was an emergency department in Pittsburgh. [Oh, okay.] So I got my feet wet initially at the emergency department, and then I was very lucky to find a position at Fairview as emergency department. So I transitioned back to Cleveland . I worked in their little small ER and I had the opportunity to grow within the clinic, and when they expanded the ER.

Carol Pehotsky: I was going to say they're not small anymore.

Mark Torok: Yeah.

So greater than a football field I understand. So you'll get your steps in for sure.

Carol Pehotsky: That's for sure.

Mark Torok: Did a lot of ER nursing. [Okay.] I went back for my master's and I spent a little time in an outpatient infusion room for the Mellon Center, so supported MS patients. [Mm.] Then I had a really great opportunity again at Fairview to go in as an an assistant nurse manager [Oh] and ironically it was right before COVID ended up getting a manager position in 2020. So it was thrown right into the fire, um.

Carol Pehotsky: Manager of?

Mark Torok: Manager of care management.

Carol Pehotsky: Oh, okay.

Mark Torok: At Fairview Hospital.

Carol Pehotsky: So straight from ED nursing to care management.

Mark Torok: Yeah. [Wow.] So, um, I had a lot of experiences with a joint venture and did a lot of discharge planning, but I saw it from the other side of things.

Mm-hmm. So it really gave me a lot of. Of, you know, information on payers and challenges of getting patients to the right level of care. So I thought that equipped me very well to kind of transition into the inpatient setting. Again, with COVID, everything was going crazy, right? But, so you learn by, by fire, but great experiences. And Fairview has a really strong group of caregivers of leaders, so I learned so much, so quickly, and then I had a really good opportunity to come over to the main campus as a nursing director. [Okay.] And that has since led me to a senior nursing director, and it's kind of where I'm at right now.

Carol Pehotsky: Wonderful. So I'm gonna be honest, I think too many of us in nursing sort of have this general idea of what care management right is that probably is somewhat flawed. Mm-hmm. So do you mind kicking us off with what really is care management? What is the scope? What is the extent? Do you have to be a nurse that?

Mark Torok: Sure. And this is a very common question. [Yes.] And there's questions, is it case management? Is it care management? [Oh yeah.] They're interchangeable. [Okay.] You can use both really. Care management is different in the inpatient setting. It could be different in the community, but I'll speak to the inpatient setting.

[Sure.] We're made up of registered nurses and social workers. [Okay.] Our objectives are always to assess patients immediately when they come into the door, and then try to align what their discharge might look like. [Okay.] So once they admit we're doing an initial assessment, you know, what's your baseline? Where are you coming from? Are you coming from home? Are you coming from a facility? What are your resources?

And then we're trying already to be proactive in setting up what is that discharge plan going to look like? [Okay.] So we get into the medical, we get into the payers, insurances, we get into the social. We cast a very wide net on what we can do for patients. [Okay.] But our objectives are to discharge patients safely and efficiently. And of course we have to line on where that will be with the patient and the family.

Carol Pehotsky: The payer landscape alone is evolving and has to be so complex. How do you and your team keep your arms around that?

Mark Torok: That is a significant challenge. And when we onboard new caregivers, we're gonna tell them, Hey, in three months you're gonna still be confused. There's so much information. At six months, at a year, you're gonna start to maybe grasp it a little bit better. [Okay.] There's so many different changes. It's trying to understand your Medicares, your Medicaids, how it's federal versus state, your commercial payers, and then we always see changes throughout the year or after the calendar year.

So we're trying to always be ahead of the curve. You know, we review CMS, we have great partnerships with our payers, so we ask them, Hey, can you please let us know if we anticipate any changes? So trying to stay ahead of it, but it is such a challenge.

Carol Pehotsky: Yeah. It might not be boosting patients and turning patients and administering 24 medications, but it's very much challenging nursing. [Absolutely.] Yeah. So. You, you mentioned that right out the gate, you're assessing patients. Mm-hmm. So let's say I'm a med surg nurse, you're a care manager. Our assessments are gonna look different. Can you tell us a little bit about that process? How you're assessing what the goals of care are, and whether a patient really is ready to go to that next phase of care?

Mark Torok: Yes. So, you know, we always, again, we wanna establish baseline. [Mm-hmm.] How many steps are in the home? Do you have anyone that live with you? So we really try to get granular on what your life looks like prior to coming into the hospital. [Okay.] What are your goals on discharge? Many patients have different goals, you know, and then we're always engaging in that conversation.

You know, we might be able to predict, Hey, on discharge you might go to this level of care, but that could change throughout the admission. So we've tried to set the table on that initial discussion with the knowledge that things could change. So we're really trying to better understand like, why are you coming in the hospital? What is your acute medical need that since changed, whatever it was from your baseline, and we wanna make sure we set up the right resources for you to be successful. When you do discharge from Cleveland Clinic.

Carol Pehotsky: I can't imagine the, the challenging conversations you've had to have with patients whose, whose goals for discharge vary widely from what their team has deemed a safe for them. [Right.] How do you manage through that?

Mark Torok: Yeah. Again, extremely challenging. [Yeah.] Many times patients will want certain levels of care and maybe they graduate and it's really not appropriate to go to that higher level of care. [Oh. Oh, okay.] And, and you know, we might have to explain, Hey, you've actually done a really good job, you've progressed. You know, you might be better served in this level of care. So things change throughout the admission. Again, we try to have those conversations and just prepare the patients and the families for what could happen.

Carol Pehotsky: Yeah. And then if the expectations are different, they, they want perhaps a lower level of care, and really the decision is that they really need the higher level of care. That's [exactly] super challenging as well. [Exactly.] How do you manage that?

Mark Torok: And patients have the right to make their own decisions [yeah] so we might have an evaluation and say, Hey, you would be best served at rehab at Skilled Nursing and they say, I want to go home. [Yeah.] Patients have that right, 110%. We can advise and try to guide, but at the end of the day, if you're alert and oriented, you have the right to make your decision on whatever that might be for discharge.

Carol Pehotsky: And I'm sure family plays a big role in that. So.

Mark Torok: Absolutely.

Carol Pehotsky: Understanding that that patient is part of a family unit. How can care managers incorporate that family feedback, but also make sure that that patient's wishes are first and foremost?

Mark Torok: Exactly. So if the patient, again, is alert and oriented, we always wanna get their buy-in on where they're gonna discharge to. [Right.] But if we have family that's involved that is critical to the success of the discharge, you know, especially if they're going home. [Yeah.] You know? [Yeah.] 'cause if a patient's new to, you know, a certain DME, or maybe they're new to tube feeds, you know, we have to have a teachable caregiver. We have to have somebody that's willing to learn the process and then goes into the home that supports the patient.

And each family is different. [Yeah.] You know, you and I might have several family members we can call and ask for help and a lot of people might not [right] you know, so we have to assess that as well. Like what resources? Do you have a neighbor that is supportive? Can you drive to your follow-up appointments? So, [oh yeah. Gosh] yeah. There are, there's such a variability in patients on the resources they have or don't have. That's why we really want to ask those questions out of the gate so we can prepare the patient to be, again, most successful under discharge.

Carol Pehotsky: Sure. So we'll assume we're all on the same page. [Yeah.] Patient, nursing team, healthcare team, care manager. What are really the key components or most important co- components to a discharge plan where you would look at that as an expert and say, this is really setting up the patient and their family team for success?

Mark Torok: Sure. So it's gonna be talking to the patient. So what does the patient want? And then we provide our clinical judgment in that conversation. You know, we evaluate the h and p, the consulting groups that saw them, their therapy evaluation, have they readmitted recently to the hospital? [Mm sure]. So we're looking at everything, not just this admission.

And then we want the patient to buy into whatever that is going to be next. So we want to have a collaborative approach. We want to speak to the, the medical teams. There's so many different caregivers that are involved that, you know, want the best for the patient. [Yeah.] But the patient, the family have to align on what that looks like. And again, that can be different from patient to patient on a daily basis.

Carol Pehotsky: Yeah. And certainly we want our patients to go out and be successful and not end up getting readmitted. Mm-hmm. So what are some things that any of us can be looking for as we're building that discharge plan to think, you know, is this a plan that the family and patient can execute that will be successful?

Mark Torok: Sure. So, you know, when you go over the discharge, not only do you go over the information with the patient, but you want to go over it with the family. You know, you and I, if we go into the hospital, it can be overwhelming and we understand what it is when we have family or families that, family members that go in.

But if you have a patient that comes in here that's, you know, not really sure of what a hospital setting is, what a discharge looks like, right, that can be so overwhelming [Absolutely.] the amount of information, the amount of people that you see. So it's, it's important to capture at the end of that admission and on discharge, eh, talk to the patient and say, do you have any questions for me? Do you understand what level of care you're discharging to? Do you understand what a start of care looks like for home healthcare? So really try to get down to the patient's level so they can understand each kind of step for them to be successful.

So it's just having those conversations with the patient and like just a good education is pivotal.

Carol Pehotsky: Yeah. You think about you know, independent of how educated we are, what experiences we have, health literacy can vary in it. And I think about either my own healthcare or with somebody I cared about the, the giant packet of papers [exactly] that's handed at discharge. [Exactly.] It's a lot for anyone.

Mark Torok: Yeah, it is. Again, I keep saying it's a challenge. [Yeah, yeah.] You know, but you know, you wanna set up everyone for the best outcome. But there are so many challenges with resources in the community, knowledge of levels of care, dealing with insurances.

You know, I want to go to this level of care, and insurance comes back and says, you know what? We're gonna deny. [Ugh.] And explaining that to the patient, the family, like, what do you mean? [So hard] I pay for my benefits. Why can't I go here? So even having those conversations are, are a challenge.

Carol Pehotsky: Yeah. Yeah. I can't imagine. So in the ED you had to discharge plenty of patients. So, and talking about going back to that, you know, how do we really make sure we set up our, our patient and family for success? So in your expert opinion, what does a good discharge education look like?

Mark Torok: So you had mentioned when I was in the ER and that was kind of where like, I didn't even know what care management was, right.

Carol Pehotsky: Discharging left and right.

Mark Torok: So at Fairview we had someone that was like centrally located and I didn't know who they were. [Okay.] And they said, oh, I'm a care manager. And I'm like, oh, what is that? You know? So you got to know them very well. Because you'd have a lot of patients that instead of just discharging and Hey, best of luck to you, [right] we would, Hey, can you go into the patient's room? Explain, you know what the admission was all about. Here's your followup, here's what we need for you next. Here are resources for shelters, for food. So, you know, in the emergency department, that was critical to get care management involved.

Carol Pehotsky: Yeah.

Mark Torok: Now on the inpatient setting here at main campus, I mean, we have patients that will discharge to the city of Cleveland, right? Throughout Ohio?

Carol Pehotsky: Yeah. Oh yeah. Outside, sometimes outside of state.

Mark Torok: International. So really we have to communicate with the patients and the family so they understand, you know, what that's all going to look like. So if they're picking a, a post-acute level of care, we give them a, a guide, it explains exactly where they're going, their star level, their quality level. A lot of 'em offer virtual tours. [Oh, nice.] You know, so if you physically here in the hospital, here's a virtual tour. We encourage family members, Hey, if this is a facility you've never been to, most of them offer the ability to tour.

Yes. So if you can have a family member, put eyes on that facility, it just makes them feel so much more comfortable. [Oh yeah. Yeah.] And really it's just aligning that we're all on the same page. We don't have any additional questions prior to your discharge. And the patient can leave happy and generally they like to go home.

You know, so we're able to align acute hospital to post-acute and then home. And they stay home and they're happy. That's everyone's goal.

Carol Pehotsky: Yeah. As we're talking, I'm thinking about, you know, again, a discharge situation where the nurse sat down at my loved one's level and had the big packet, but said, I have to give you all these papers, but I'm going to highlight what's most important for you [exactly] to be able to stay out of here and to be healthy, and with her little highlighter and her pen and writing upside down.

But whether you're a care manager or a bedside nurse, there's really simple things you can do to really assess. You know, I'm watching my loved one the whole time 'cause I understand but making sure that they do and just there's so much impact a nurse can make on really assessing that.

I've, I've told you these things [right] do you understand them?

Mark Torok: Exactly. Yeah. And it's so nice that we, our department is not only just registered nurses but social workers. [Yeah.] Because it feels like our percentage and it's anecdotal of patients that are coming in with social concerns [Sure] are increasing.

We can put a consult in for social work to see the patient. Many times they can spend, you know, more than a couple minutes speaking with that patient and fully assess what is going on from the social aspect. You know.

Carol Pehotsky: That's probably a great vantage point to have across your team to have those different backgrounds.

Mark Torok: Absolutely. And you know, we have amazing caregivers. We have amazing RNs, we have amazing social workers. We have an awesome social work team lead [yeah] you know, that, that leads us and it's just all the resources that we have here are incredible. And if we didn't have the whole team working, you know, in sync, I don't know where we would be.

Carol Pehotsky: Right. So I come from an area that doesn't normally have coverage from care management and surgery and you mentioned the ER sometimes too. So for those of us who, who aren't in units, they're traditionally an inpatient unit with a care manager, you know, we have been very fortunate when we've had concerns, we have been able to reach out to care management, [right] and say like, I don't feel comfortable with this discharge.

So those of us who work outside of that more traditional inpatient nursing world, when should we be reaching out to say, I think I could benefit from a care manager or a social worker here?

Mark Torok: Yeah. So you know, there's a lot of different outpatient resources that we can try to align patients and families with. So it's not just inpatient is the only space you're gonna see a care manager. [Right.] A lot of your insurance's have care managers. So if you're, if you have a Medicaid plan, we try to encourage, hey, align with a care manager who will follow you back out into the community.

Carol Pehotsky: Ah, yeah.

Mark Torok: You know, PACU is kind of a gap and I know you and I told that we know.

Carol Pehotsky: We can, yeah. We wave the white flag, but we need help. Exactly. And we've always gotten it.

Mark Torok: Exactly. And, and we're happy the partner, you know, and that's generally where you escalate it up to management if there's a significant issue and that's where we'll jump in and try to help. Whatever that might be, again, we're, we're trying to collaborate for the best interest of the patient.

Carol Pehotsky: Yeah. And, and truly, folks we don't call very often, but when we have Mark or his colleagues have been right there, it's, it's never a, no, we don't cover your unit. It's a tell me more about what your, your concern is and let's work together.

Mark Torok: Exactly.

Carol Pehotsky: Yeah. And, and everybody out there should be calling your care managers and should be getting that exact same response. So we, we wanna make sure our patients are ready to go to the next stage and are supported in that. So we have tiered huddles here at Cleveland Clinic, and I have the great opportunity to lead them, and it's at least every couple of months there's a shout out and a celebration of a caregiver.

Often a nurse who patient was ready for discharge, mark for discharge is, is working on helping get that patient on their way and something doesn't look or feel right. They stop the line. And it turns out that whether it's through an EKG or a lab result or something else, that patient was actually in harm's way, we were able to stop it and redirect and pause that discharge. So, you know, we talk a lot about nursing intuition and that's hard to measure, but what should nurse be doing? How should I be looking for that this is a great plan, but I still have a patient in front of me?

Mark Torok: So you know, there's protocols in place, right? It's some things are black and white.

As humans, we have to look at it in a different direction, right? So we have to lead with compassion. We have to try to better understand the stress that that patient is going through. So clinical changes of course are red flags, right? A precert that comes in late and we can't get a transport till nine o'clock in the winter when it's snowing out. Is that really in the best interest of the patient to discharge that late in the evening is at the safest route? [Oh, yeah.]

So we're always looking to make sure, you know, if a patient's leaving our building, we want them to go where they're going and stay there and be successful. [Yes. Yeah.] So, you know, if we have to delay a discharge because something looks off, maybe we'll give them one more night.

We'll collaborate with the medical team, make sure we're on the same page, communicate with the family and just say, Hey, maybe one more night is good for you here. You know, and it, it, that's variable. But, you know, changes in clinical conditions, again, we just want the safest and best outcome for all of our patients.

Carol Pehotsky: Well, and it's a great point that I can think I'm ready to go but just the act of leaving is a stressor. And does that then change my physiologic condition as part of that stress?

Mark Torok: Absolutely. And you know, we don't tell the patient on day of discharge, Hey, you're discharging today. ]Right.] You know, we always try to give them a little bit of prep. [Yes.] You know, hey, 48 hours before the the discharge, we're going to initiate your pre-cert. We're setting up home health care, and there's a good chance you're gonna discharge on X date.

You know, so we try the forecast to the patient and the family so they're not surprised. [Yeah.] You know, they're not at the end of the admission saying, whoa, whoa, whoa, I'm not ready to go.

Right. You know, we're having those conversations ahead of time, so they kind of have a good understanding, all right, I'm leaving on Tuesday. Here are the things I need to get from home. Here are the family and friends I need to alert. So forecasting those things, it might not always go as planned. Right. But we're always trying to give the patient, you know, that information ahead of time.

Carol Pehotsky: Yeah. Yeah. I'm sure that is very, very helpful. So we've talked a lot about families, but as you mentioned so wisely, there isn't always a network of folks that a patient can turn to. Talk to me about how you evaluate a patient support system, the home environment, and what resources are out there.

Mark Torok: Sure. So of course we're always looking at our social determinants of health. You know, where do you live? What support looks like in the home. For 2026, there's gonna be a CMS mandate for, it's called age friendly. [Okay.] So this is for patients that are greater than 65. [Oh yes.] All patients that enter the door greater than 65 in the ED, in the inpatient setting, we have a few different type of questions we're gonna ask them.

[Okay.] It's kind of in addition to our social determinants of health, and we're adding caregiver stress, we're adding elderly abuse. So we're getting really into more of the specifics of those questions. So in 2026, that's gonna be a new mandate that we're gonna have to implement. So in quarter four of 2025, we should have it up and running. We should work out the kinks.

But how are we gonna ask those questions on that initial assessment and then prior to discharge, we have to reassess [Yeah] to see if there's anything that has changed. And you know, more often than not, maybe the answer is no. But we have to reassess just to make sure, again, for the patients that are greater than 65, they have all those resources to be successful.

Carol Pehotsky: And so that, so even if you're not a Cleveland Clinic caregiver, that's a CMS mandate. [Exactly.] That's not a, a decision our organization's making. So if you're listening from outside the Cleveland Clinic, you may wanna talk to your colleagues to make sure that they're ready for this. Right?

Mark Torok: Yeah. And you know, we try our best to collaborate with our other community partners. And you know, more recently we said, Hey, FYI, there's this age friendly thing coming out and they're like, oh, what do you mean? [Oh gosh. Yeah.] So that goes back to, you know, having the, uh, the information ahead of time so you can make those educated decisions. You can prep your teams, you know, 'cause this is definitely gonna impact our workflow from a care management perspective.

Carol Pehotsky: Sure. And making sure that your EHRs and integrating those questions and such so that teams know to document it and that there's that communication across [exactly] as well. [Exactly.]

So thinking about I'm a bedside nurse, what would your care managers want a bedside nurse to know about how to sort of think like a care manager? What sort of things should we be thinking about in our everyday care, whether we're in an inpatient nursing or not, to, to sort of peek into the mind of a care manager work together?

Mark Torok: Yeah, it's a good question. Baseline, you know, what is the patient presenting as from a nursing perspective and like, are they graduating? Are they getting out of bed, are they ambulating? You know, we might advocate for a certain level of care, but the nurse is saying, you know what, I don't know if that's gonna go well. I don't know, you know, or if they have different changes, you know, so just understanding like where the discharge is going and getting that information from the nurse who's caring for the patient for 12 hours.

You, you know, that's so pivotal to collaborate with the bedside nurse. You know, we're not gonna ask you guys, the nurses, to better understand what payers look like, what an insurance research looks like. [Appreciate that.] Like, you know, but we really need a good line on, you know, when is the family coming?

Are they only coming at night? Is it a variability on who's coming in? Are there no family at all and we're gonna discharge the patient home? So having that sort of information. [Yeah.] You know, especially when patients do want to go home, you know, 'cause patients might tell you one thing and in reality, so you know, having that insight from the bedside nurse would be so helpful to care management, just so we know that we're aligning the patient again for the best outcome.

Carol Pehotsky: Documenting it so that if we don't have a chance to connect with you, [yes, please] you have that resource there. So despite all the best plans, sometimes discharges don't go as planned. The patient does leave and they either get readmitted or things just don't go the way any of us would want that to. Can you share with us when that can happen and lessons learned that we could take from that?

Mark Torok: Yeah. Yeah. So anytime we're onboarding a new care manager and you're planning a discharge, it's not just one discharge plan, it's plan A, it's plan B, and it's plan C. You know, at the very least, right? X amount of percent of time plan A is gonna go well, but we have to have those plan B's and C's so we can pivot when appropriate and we wanna discuss it with the patient.

You know, we don't want to be planning things behind the curtain and the patient wasn't even aware of it. We wanna provide that information. Hey, if the insurance doesn't approve this, you know, we can go do a peer-to-peer, we can go to an appeal, but if, if it's not approved, [yeah] these are the next steps we're gonna have to take. These are the resources we're gonna have to look into, the phone calls we'll have to make for you.

So every day we're running into challenges. Again, back to the challenge word of trying to align the best discharge and, and sometimes it doesn't go as planned and it maybe it's out of our control.

But orienting the patient and the family on plan A, B and C is, is very critical.

Carol Pehotsky: So it strikes me that to be a, a skilled care manager, you need to be creative to an extent. [Yes. Yes.] Uh, what are some other good, I, I bet you've probably inspired several listeners to think about care management as a career path. What sort of attributes and skills really help somebody be the most effective care manager they can be?

Mark Torok: Yeah. I, I think care management is such a unique opportunity [Yeah] within the hospital 'cause you use your clinical judgment, but not every day is the same. Right. You know, so you, you have to be creative, you have to be quick on your feet. You have to be able to multitask, to prioritize. You know, amongst your 16 patients, who am I gonna go see first? [Yeah.] Who am I gonna task to get a pre-cert initiated?

So prioritization, time management is critical and yes, you sit a lot in your chair, but you're up on your feet speaking to family members walking down the hall, so you have to be in physically pretty good shape too.

Carol Pehotsky: Sure. There's a lot, a lot of miles to cover to get to all 16 patients.

Mark Torok: Absolutely, yeah. You know, ideally if you have some experience within the health system, if you've been a nurse before, that is helpful. You know, we have onboarded brand new, new caregivers, fresh outta school. [Really?] Yeah. A lot of our social workers, you know. [Oh sure.] Yeah. You know, they might have a master's degree and they might come into our, our building fairly fresh. [Yeah.] You know, and we've actually had a lot of really good successes, onboarding new caregivers that don't have much experience.

You know, nurses, of course, they might have worked, you know, in nursing facilities or acute rehabs or bedside. All of that is critical, again, to kind of understand, like what does a discharge really look like? [Right.] You know, so there are so many different skills. It's not a one size fits all. You know, we have caregivers in the emergency department and labor delivery and ICU. So whatever experience you can bring to the table, care management's a really awesome opportunity to get into the operations of the hospital, you know?

[Yeah.] And, and really, you, you have a feeling of you're impacting not only the patient but like the whole operation of the hospital and I think that's a pretty unique feeling.

Carol Pehotsky: Especially these days in healthcare. Right? There's somebody waiting for that inpatient bed, but we obviously wanna make sure that patient leaves in a safe fashion [Exactly] and ideally doesn't come back.

Mark Torok: Exactly. Yes. We wanna give them the resources so they are successful in the community. Successful at whatever facility they go to. If they have to readmit, we understand, but we're trying our best to make sure that doesn't happen. It's really not in the best interest of the patient to readmit as well.

Carol Pehotsky: So we do have lots of listeners from within Cleveland Clinic, but we have some that probably aren't. And so you've mentioned age friendly, there's definitely some homework they should be looking into. If I'm a med-surg nurse from a different organization, what are your recommendations for learning more about what care management resources are in my hospital or how to make sure my patients are getting connected with those resources?

Mark Torok: Yeah, so CMSA would advise anyone that's interested in care management to join CMSA. You don't even have to be a care manager, but you can just get involved. You know, Cleveland has a chapter. There are many chapters outside of Cleveland that you can join. There's so many things on social media as well. LinkedIn, you can get so many different resources. I just like the Google, you know, and go on and see kinda what's going on. Like what are, what changes are we gonna see?

You know, we know a lot of Medicaid and Medicare changes are gonna come at the end of 26 and end the 27. So there's just like so much out there. And ask a care manager if you're a bedside nurse, if you're somebody maybe in the pacu you know, ask, ask a care manager, what is it that you love about your job? [Yeah.] You know, why would I wanna join this team? And I'm very confident that a lot of care managers in, you know, it doesn't have to be Cleveland Clinic, will speak to the value of the position and the impact that they can have.

Carol Pehotsky: Yeah. Wonderful. So I can't thank you enough Mark, you've, you've shared so much, really rich, wonderful information with us today. Before we call it a day though, I'm hoping you'll humor me with some speed round fun questions. [Absolutely.] So first off, it's finally time to unwind. You're a very busy gentleman, but it's finally time to unwind. What do you do to recharge?

Mark Torok: Yeah, great question. A sports junkie. I like, [okay] I golf or I try the golf. I like to go to the, you know, Guardians games, Browns games. I love spending time with my wife. We like to go hiking [Nice]. And go to the national parks when we get PTO hang out with our dogs. Um, really, I like to be home if I'm not doing sports. [Sure.] You know?

Carol Pehotsky: How many national parks have you gone to?

Mark Torok: We're gr- we're over 10.

Carol Pehotsky: Oh, nice. Oh.

Mark Torok: We just got to Glacier National Park. [Oh, cool.] That was outstanding. Yeah. Uh, we liked it so much we're considering going next year. If you haven't been to any of the national parks, I mean, we have Cuyahoga Valley National Park right here in our backyard, but national parks are, are so fun for us and challenging ourselves with hikes. [Yeah.] And just seeing new experiences.

Carol Pehotsky: Wonderful. And Cleveland Clinic, you know, spent a lot of time this year talking about the power of purpose. So, as we close that, I, I'm hoping you're willing to share with us what's your why.

Mark Torok: Yeah. So, you know, fresh outta high school, I just wanted to be able to help people. And I know sometimes that could sound cliche, you know, I was thinking, do I go in the fire? Do I go into nursing? And nursing was always something that like drew me for whatever reason, even when I was like in grade school and in early high school. So having the ability to help people has always been something, you know, it's kind of why I wanted to go into the emergency department.

[Yeah] You go in there, it's so stressful. It happens so quickly. Like how can I try to comfort a patient [sure] in that setting. And then of course, evolving in the care management. You go through the whole system, you're stressed. How do I set you up to be successful? Like there's so much value in helping patients as a bedside nurse, as an ER nurse, but once you can move them to the right level of care and families are thanking you. And we even get calls and texts after they are, [oh, that's wonderful] going home or going to a facility. And then, hey, thank you so much for helping us and taking the time to answer those questions. And you know, that makes you feel good when you leave work.

Carol Pehotsky: For sure. Well, thank you so much for joining today.

Mark Torok: Thank you, Carol. I appreciate it.

Carol Pehotsky: As always, thanks so much for joining us for today's discussion. Don't miss out. Subscribe to hear new episodes wherever you get your podcasts. And remember, we want to hear from you. Do you have ideas for future podcasts or want to share your stories? Email us at nurse essentials@ccf.org. To learn more about nursing at Cleveland Clinic, please check us out @clevelandclinic.org/nursing.

Until next time, take care of yourselves and take care of each other.

The information in this podcast is for educational and entertainment purposes only, and does not constitute medical or legal advice. Consult your local state boards of nursing for any specific practice questions.