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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I'm going to be really honest here. I didn't become an emergency physician in order to interact with patients or change lives or make a difference. Not that those aren't incredibly good and worthy reasons to become a healthcare professional. But they weren't driving forces for me personally. I became a physician because I loved the practice and the study of medicine.

When people would ask me what I enjoyed most about my job, I would answer, “everything!" I loved the pace, the sounds, the smells (well, not all the smells). I loved managing multiple critical patients at the same time, dashing between a trauma in room 1 and a code in room 2. I feel great — truly alive — while doing my job.

Love of medicine for medicine's sake served me well for many years. But then I had a not-so-comfortable experience that made me realize something important was missing from my personal practice.
1/22/2015 12:34:16 PM | 5 comments
Up until December 2014, my Partners and I at Group Anesthesia Services (GAS) maintained a successful, five-decade-long practice at Good Samaritan Hospital in San Jose, California.
Our highly respected practice benefited from an informed and engaged patient population, a favorable payer mix and talented and collegial surgical colleagues.  We easily recruited from top residency programs and had great relationships with our facility administrators.  Most importantly, we provided safe and efficient surgical anesthesia to some of the sickest and most fragile patients. 
So, why did we choose to join an integrated acute care practice in which specialties such as emergency and hospital medicine could easily overshadow our own? 
1/20/2015 12:19:00 PM | 0 comments
Last time I posted on Perspectives in late 2013, it was to predict a New Year’s like no other.
Acute care providers everywhere were scrambling to prepare for an influx of newly insured patients on Jan. 1. The Affordable Care Act (ACA) had been designed to reduce ED crowding, yet most emergency departments (EDs) were bracing for increased volumes. Healthcare leaders knew that access to primary care could be a thorny issue for the newly insured, leaving only EDs to meet their needs.
1/15/2015 7:45:55 AM | 1 comments
The past decade has been a period of great uncertainty for healthcare leaders, who've been charged with implementing a sweeping redesign of the entire industry. We frequently watch bills pass into law and wonder what regulations will follow. Population health, bundled payments and clinical integration are touted as the way forward, but essentially these key programs, like many others, are being designed on the fly.

On the other hand, openness to change is essential to move teams and organizations forward in creating better care for all patients. So how can we foster resiliency in uncertain times? One way is by cultivating the mindful habit of Trust.
1/13/2015 6:35:44 AM | 1 comments
In Tuesday's post, Gail Silver, MD, discussed the evolving role of the emergency department (ED) within the Acute Care Continuum. As an urgent care provider, she was concerned about the number of highly acute patients presenting to her practice when they clearly needed emergency care. She noted that in addition to providing life-saving care, EDs also offer care coordination services that connect high-risk patients with needed follow-up and community resources.
As an emergency physician, I strongly agree that EDs can and should play a pivotal role in facilitating transitions of care — and ultimately in breaking the cycle of repeated ED visits and hospitalizations that underserved patients often experience. I feel fortunate that my state (Oregon) is pioneering an approach that could serve as a blueprint for coordinated care programs nationwide.
1/8/2015 12:28:01 PM | 1 comments
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