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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On my first day of medical school, during introductory lectures, the dean said something that seemed a little radical:

"At least 50 percent of everything we teach you in the next four years is going to be proven wrong at some point in the future. The only problem is, we don't know which 50 percent that is."

Those words are particularly salient today as our system begins its shaky transition away from fee-for-service toward population health management. Today's physicians must adapt and evolve not only clinically, but in the realm of care delivery as well.

8/28/2014 8:00:15 PM | 0 comments

Four years into healthcare reform, change fatigue is pretty common among healthcare providers. We're overwhelmed with metrics and mandates. We're held responsible for patient outcomes we sometimes feel helpless to control.

On top of it all, we're expected to provide excellent customer service. The patient experience piece often draws resistance from change-weary providers. After all, they're providing excellent clinical care. Isn't that enough?

As a practicing emergency physician, I definitely have empathy for this viewpoint. But recently, a colleague told me a story that really drives home the link between patient experience and outcomes.

8/26/2014 3:37:38 PM | 0 comments

By Jeffrey Frank, MD, MBA; Doug Lange, MD; Rick May, MD; Peter Rowe, MD; Reid Rubsamen, MD; Ryan Green, MD; Eric Fulkerson, MD; Catherine Hurt, MD; Teri DeLaMontanya, RN; and Barbara Harris, RN

Reducing complications (and ultimately morbidity and mortality) among hip fracture patients is a crucial quality goal for many hospitals. Here's how John Muir Medical Center – Walnut Creek (Calif.) achieved excellent outcomes for hip fracture patients using a unique interprofessional approach.

The following post is adapted from a poster presented at CEP America's 2013 conference.

8/19/2014 5:36:02 PM | 0 comments

These days, we do not really need to be reminded that the landscape of healthcare is changing rapidly. One clear trend is toward the increasing employment of physicians. This includes employment by hospitals, hospital health systems, medical groups, and other entities.

Merritt Hawkins, a national physician recruitment and consulting firm, recently released its 2014 recruitment survey. The results are astounding — less than 10 percent of recruiting searches from April 2013 through March of 2014 were for independent practice positions, such as solo practice or partnerships. (Contrast that with 2004, when 45 percent of job openings were in independent practices.) Of the remaining 90 percent of searches, a large majority were for employed positions.

8/14/2014 5:45:53 PM | 0 comments


In a 2013 Acute Care Continuum Blog post at Perspectives, we discussed the issue of pediatric ED providers undervaluing their services through incomplete documentation and inaccurate use of evaluation and management (E/M) codes.

But lately in our audit practice, we've also noticed that another service, critical care (CC), appears to be underreported by providers working in pediatric EDs.

What exactly is critical care?

8/8/2014 10:38:56 PM | 0 comments
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