The Acute Care Continuum is the integration of urgent, emergent, inpatient and post-discharge care of patients with acute medical conditions.
A few months ago, I walked into work on a late-night shift. One of the nurse practitioners came up to me and said, "There's someone you need to see right away."
The patient was a woman of about 60, and it was clear that she was critically ill. According to her husband, she'd been diagnosed with cancer six months ago. It had metastasized throughout her body. Her oncology team made several referrals. In fact, the couple had spent the last two days traveling to see a specialist in another city. Signs pointed to a perforated abdominal organ — probably caused by one of her metastases.
Maximal intervention would require intubation, placement of a central line and a rush to the operating room for an emergency laparotomy. And even then, I doubted she'd survive.
"We've called respiratory therapy. Are you going to intubate her? Should I get the levophed?" the nurses asked.
I had a choice to make.
In theory, it was a fantastic idea. Ingenious Med, a hospital charge capture solution, would allow hospitalist physicians to enter billing information directly into the system via their mobile devices or web browser, eliminating a previously manual and paper-based system.
The product promised to unify coding, communication, revenue and business intelligence in a single platform. Its potential seemed limitless.
But for CEP America, getting Ingenious Med off the ground presented a new challenge. Implementation required close coordination with the IT departments at multiple CEP America hospitalist sites — plus managing relations with an outside vendor.
It is Monday afternoon. Two cardiac monitors are beeping behind me, worsening my tinnitus. There is an elderly patient moaning, and my nurses keep asking me questions as I'm entering orders in Cerner (our EMR). "It can"t be that bad again," I optimistically tell myself.
Then I realize as I walk toward the entrance that there are four ambulances lined up in the bay, that our beds are full, and that there is a 60-year-old gentleman who has been patiently waiting in the waiting room for three hours to see a doctor.
It is that bad again! Shifts like this made me realize that we had to come up with new ways to serve our patients.
On April 22, 10 teams participating in CEP America's Emergency Department (ED) Throughput Collaborative pilot program gathered to share their progress over the past six months. This year-long collaborative learning initiative aims to accelerate improvement in ED turnaround time to discharge (TAT-D) with the goal of sharing learned outcomes and best practices with the wider organization.
The teams first came together in October 2013 for a two-day session in which they learned about evidence-based improvement practices and strategized with their teams. Over the next six months, they implemented rapid tests of change and engaged in monthly touch-base calls with collaborative leadership, who provided coaching and encouragement. The question we raised back in October was "could our organizations accelerate change by working together"?
Now we'd finally see data on their progress.
Medical professionals might or might not see themselves as leaders. Yet to the rest of the world — and to their patients in particular — they most certainly are.
Patients are expecting direction, confidence and composure from their medical providers. Doctors are expected to display clarity and courage in the face of the overwhelming uncertainty their patients and teams are faced with daily.
Leadership in the face of such demand and uncertainty is required, not optional.
While research exists examining the dominant leadership skills appreciated in medical practice environments (e.g., hospitals, clinics and emergency rooms), training programs that groom physicians into leaders able to perform while achieving greater balance at work are rare.
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Congratulations on a job well done. Love your focus on the patient experience!
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