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. 

Healthcare Leaders Send Powerful Message About the Value of Care Coordination

7/11/2016 1:57:55 PM | 1 comments

CEP America and Palomar Health executives will be among the top healthcare leaders speaking at the 2016 Health Forum/AHA Leadership Summit on July 17–19 in San Diego.
Their presentation, “A Patient’s Journey: What a Single Patient’s Story Tells Us about the Value of Coordinated Care,” will discuss tangible benefits achieved at Palomar Health, where CEP America manages the emergency medicine, hospitalist medicine, critical care, and psychiatric inpatient services.
Presenters will include:
  • David Birdsall, M.D., Vice President, CEP America
  • Robert Hemker, President and CEO, Palomar Health
  • Sabiha Pasha, M.D., Medical Director of Hospital Medicine Services
  • Jaime Rivas, M.D., Medical Director of Emergency Medicine Services
In today's post, our speakers share some personal reflections on care coordination and hopes for the presentation.
Perspectives: For each of you, was there a particular patient who drove home the importance of coordinated care?
Sabiha Pasha: I hope this isn't a spoiler, but mine is the patient we're going to talk about at AHA. She was an elderly woman who was admitted to our hospitalist service with C. diff. colitis and developed septic shock. She came out of the ICU severely deconditioned, still with profuse diarrhea, and swollen all over her body.
It didn't look like she would recover. Her daughter had already signed a DNR. But during our goals of care conversation, the patient declined hospice and said she wanted to live.
CEP America hospitalists also staff some skilled nursing facilities near Palomar Health, and one of those "SNFists" brought this woman over to his facility. Over the course of two months, he slowly nursed her back to health, visiting her daily and managing her closely. When she had an episode of chest pain and atrial fib, he worked with our ED and hospitalist teams to coordinate cardioversion and a same-day stress test. So instead of being readmitted, she was discharged back to the SNF.
The patient was eventually able to walk again. And when she left the SNF, she walked home.
Perspectives: Wow, you mean that literally?
Sabiha Pasha: She really walked.
Jaime Rivas: I was working an ED shift at Pomerado Hospital, when a patient came in with what turned out to be DVT. He was really friendly and outgoing, and we ended up chatting about his past as a professional athlete.
He mentioned in passing that he was also having a bit of chest pain during exertion. Just to be safe, I ordered some tests, and sure enough, his troponin came back elevated. Cardiology wanted him admitted at Palomar Medical Center, so I called my CEP hospitalist partner over there, and together we organized everything.
As it turned out, the patient ended up having an emergency bypass the same night. Afterward, one of my CEP intensivist colleagues cared for him in the ICU.
My first thought when I heard this was, Wow, that's one lucky guy. But it was also pretty gratifying to see this line of handoffs falling into place. Teamwork — both among our CEP colleagues and with the surgeon and cardiologist — ensured he was in the right place at the right time getting the right care.
Robert Hemker: It's not a specific patient story, but one initiative that's benefited many Palomar Health patients is our low-risk chest pain program. It's the result of over a year of collaboration between our emergency medicine and cardiology departments. When testing shows that a chest pain patient is at low risk for a cardiac event, the ED team coordinates same-day follow-up at an outpatient cardiology clinic. This spares the patient a lengthy inpatient evaluation — and the costs and anxiety that often go with it.
David Birdsall: I practice in the ED at John Muir Medical Center in Concord, and a couple years ago, we had a patient come in for a medication refill … by ambulance. A lot of hospitals would have assumed he was trying to game the system to get seen faster. They'd have sent him to the waiting room. But we put him in a room, and the nurse and doctor went in to talk to him.
Turned out the patient was this very frail, elderly man who had just been discharged from our hospital. The hospitalist had emphasized the importance of taking all of his medications properly. But when the patient went to his neighborhood pharmacy to fill his prescriptions, they were out of one medication.
The patient totally panicked. He was convinced he might die. So not knowing what else to do, he called 911.
In hindsight, we were so glad we took the time to listen. We were able to contact his hospitalist and clarify his prescriptions. And then the ED pharmacist contacted the local pharmacy, and the nurses worked with the family to make sure they knew what to do and where to go. We had about seven people working together to coordinate this guy's medication refill. The teamwork was great to see. It was also a great learning experience that helped us close some gaps in our discharge process.
Perspectives: What do you hope the audience will take away from your presentation?
Jaime Rivas: Having a multispecialty group manage multiple service lines is step one. But the next level is actually integrating care — setting up the communication, collaboration, and pathways that allow you to function as one team.
Robert Hemker: For me, it's about focus and accountability. In order to deliver coordinated care, everyone in the organization must take full responsibility for the patient, even when it means reaching beyond your usual duties and department to ensure a Patient First experience.
David Birdsall: Care coordination isn't easy. But as these stories illustrate, it's vital that we get it right, because it's what's best for patients. So surround yourself with believers. There really are physicians and groups out there who are passionate about helping you get there.
Sabiha Pasha: When we step forward, keeping the patient front and center and working together collaboratively, the patient's best hopes and outcomes can be realized.

john fredericks
These patient stories showcase how when our acute care partners communicate and collaborate across their practice lines to bring about coordinated seamless care transitions, the patients benefit from excellent care, reduced medical errors and have a highly satisfying patient experience.
7/13/2016 3:48:07 PM