Perspectives on the Acute Care Continuum

The Acute Care Continuum is the integration of urgent, emergent, inpatient and post-discharge care of patients with acute medical conditions.

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When I was a resident, chest pain was all about the story.
During one history, I learned that my elderly patient was a ballroom dancer. "How long did you dance for?" I remember asking. "Was it a vigorous type of ballroom dancing?"
Today, I look back on those encounters with a certain nostalgia. Back then, the clock never seemed to be ticking. I had time to weigh the evidence and consider "zebras" (unusual diagnoses). Best of all, I really got to know my patients and hear their stories.
Sometimes during case discussions, an attending physician would describe "what we’d do in the real world." This always confused me. As the last stop in our training, shouldn't residency be as close to real-world practice as possible? Read More...
4/16/2015 2:23:40 PM | 1 comments

A 70-year-old patient with a total hip replacement is taking a while to heal and she is having trouble with mobility. Her orthopedic surgeon and hospitalist agree she’s at risk for complications and recommend discharge to a skilled-nursing facility (SNF).
While this may sound like common sense, it’s a crucial decision for both the patient and hospital. On one hand, if the SNF communicates with the hospital and the two facilities align their hip replacement protocols, the patient will be in great hands. But without care coordination, this woman could end up sitting in bed, putting her at risk for pressure ulcers, nosocomial infections, and readmission to the hospital. Read More...
4/14/2015 2:12:58 PM | 2 comments

CEP America’s one-year administrative management fellowship helps physicians develop the skills they need to lead in challenging times and transform the delivery of healthcare. Fellows are mentored by the group's leadership and have the opportunity to work on projects related to quality, risk, advocacy and continuing education.
Perspectives recently sat down with two of our current fellows to talk about their experiences and how they plan to use their learning in their future careers. Read More...
4/8/2015 1:28:11 PM | 1 comments

Several years ago, Sharp Chula Vista Medical Center (Sharp CV) in Chula Vista, Calif., added a dedicated pharmacist, Kim Schwab, to its emergency department (ED) team. Schwab quickly noticed there did not seem to be established guidelines for ordering cultures. As a result, wound cultures were ordered indiscriminately. This cost the hospital money and took staff time away from patient care.
Beginning in 2013, Schwab teamed up with pharmacy resident Hazel Tran and biostatistician Ron Floyd to see if collaboration between pharmacists and front-line providers could make a difference. The following is adapted from a poster presented at CEP America's 2014 Partnership meeting. Read More...
4/2/2015 1:43:21 PM | 0 comments

In my previous post, I discussed some of the evidence linking general anesthesia in childhood to cognitive problems later in life. To recap, both humans and animals who received a general anesthetic early in their development appear to have trouble with recollection, the act of retrieving events and information from the past.
Experts and professional societies are sufficiently concerned to recommend these risks be discussed with parents and caregivers. However, this creates a bind for pediatric anesthesiologists. For one thing, we don't want to cause undue alarm to families who are already anxious about a child's surgery. Second, we're constrained by gaps in the existing evidence. We think there could be a link between general anesthesia and cognitive deficits, but we can't yet say so for certain. Nor can we promise that any of the available alternatives won't cause the same issues. Read More...
3/31/2015 12:18:08 PM | 0 comments
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