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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While the rest of the country debates the political and legal ramifications of the Supreme Court’s decision to uphold the Accountable Care Act (ACA) almost in its entirety, what’s next for those of us on the front lines of providing care?

Hospitals, physicians, and other providers have had mixed strategies for responding to the ACA as we all waited for the Supreme Court’s decision. Some organizations have moved full steam ahead with implementing some of the changes required by reform, while others – already overwhelmed with other initiatives – have waited for this decision before making any moves.

6/29/2012 6:26:25 PM | 6 comments

It goes without saying that most patients arrive to the ED in a flurry of chaos, stumbling over their words, embarrassed about the circumstances that brought them there, and about the lack of planning that led to the emergency in the first place. The majority of the time, their “emergency” is stabilized and they are sent home (as Mark Spiro noted in his post, not all ED visits are emergencies). Yet, the stress of the visit will linger, the trauma or drama will cloud their understanding of their condition and the discharge instructions.

Emergency Medicine research studies show the patients’ retention of discharge and medication instructions from EDs ranges about 25-30% at best. These same patients are asked to take that 30% of retained information and try to engage in follow up care, fill the prescriptions and understand our verbal and written return precautions.  But do they?  The same studies show that patients rarely make follow up appointments, only fill prescriptions half of the times, and some even return within a few hours or days to go through it all again.
6/28/2012 9:43:45 PM | 0 comments

The patient navigator shows how a small scale change and modest expenditure could quickly yield improvements in ED resource utilization while at the same time providing much needed support to patients. This could be a “win win” for patients, hospitals and ED staff.

Patient navigator programs, an example of which is currently in use at Sutter Health emergency departments in Sacramento, attempt to broaden the help given to ED patients. The program at Sutter General and Sutter Memorial Hospitals is still very new, with the pilot phase just completed in the fall of 2011.  It places patient navigators, usually trained social workers, in the ED.  Their job is to assist patients who do not have access to follow-up care. 

6/26/2012 8:27:16 PM | 0 comments

I read the recent CDC report on “Emergency Room Use Among Adults Aged 18-64: Early Release of Estimates From the National Health Interview Survey, January-June 2011”[PDF] and felt compelled to respond. As an emergency physician helping to lead a physician group which sees four million emergency patients per year, I had both an intellectual and emotional response to this article.  My comments are about this specific article as well as the general issue – the widely held belief that there are too many ED visits. I hope my ED based perspectives will be viewed as helpful and not defensive.

I have doubts about the conclusions based on the data because of the retrospective design of the study and the small number of surveys used. Most of these studies were done retrospectively based on discharge diagnosis. One conclusion from the CDC study was that only 54.5% of visits required a hospital for their care, suggesting that only these patients had true ‘emergencies.’ The lay public are often very unaware as to what is a serious problem needing emergent or very urgent care versus a not so serious problem—especially prospectively.

6/20/2012 12:09:02 AM | 2 comments

Recently, the Report on Medicare Compliance (from Atlantic Information Services) published an opinion article about the use of scribes in healthcare.  The premise of the article was that hospital executives and physicians should re-examine the benefits of scribes because compliance risks grow when scribes are allowed to make entries into electronic health records.  Furthermore, the article questioned the gains in physician productivity from scribe utilization.

Are these authors practicing physicians themselves?  Do they understand the growing clinical pressures and demands placed on healthcare providers today? Have they ever used an EMR in an acute care setting (like an ED) where providers are expected to see upwards of 3 patients per hour?  My guess is that they have not.

I believe that the authors are not only misinformed, but that their article will hinder the advancement of EMRs and the modernization of the healthcare workforce. 

6/19/2012 11:54:00 PM | 0 comments
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