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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The physician I work with calls me his “right hand man”.

As the worlds of software technology and medicine continue to become more intertwined, scribes are playing an important role in the transition to electronic medical record (EMR) systems in the emergency room.  EMRs are a solution for the future in saving time and money in healthcare.  Based on my experience as a scribe, I can see that scribes are a bridge to the future between the medical world and the software world.

The purpose of scribes in the emergency room, according to Jason Ruben, MD, is to document treatments at the physician’s direction so that the doctor can focus on patient care.  The physician I work with says that, thanks to my work, he “goes home on time.” This is because I save him hours he would have to put in charting at the end of his shift.

11/28/2012 9:32:33 PM | 6 comments

In Victorian London, people were used to death. But the cholera epidemic of 1849 had people afraid to breathe, believing that cholera was an air borne illness. One letter from the time describes a hard-hit area, “The inhabitants themselves show in their faces the poisonous influence of the mephitic air they breathe. ”

John Snow, MD, learned otherwise.  When he placed small rectangular bars representing cholera deaths on a map of London, it showed clearly that the deaths were clustered around an infected water well. The day officials removed the handle from the Broad St. pump in London was the last day of the cholera epidemic, which had taken over 50,000 lives. Snow’s map is now included among important texts of information visualization and is considered the birth of epidemiology.

11/27/2012 6:49:21 PM | 5 comments

Regardless of whether you support the outcome of the November 6 election, every American can take pride in being a part of a democratic society "of the people, by the people." I am often asked by physicians of different organizations how this spirit transcends from politics to our democratic practice model and what it is like to be part of a large democratic physician group.

My democratic physician group is analogous to a representative democracy, with an elected board selected by the Partners, who appoint an executive who is accountable to the group. Most important to our practice model is that each partner is an owner of the organization and has a vote. The partners’ votes determine the direction taken by the group. This is in contrast to a publically owned or private equity company, where investors hire leaders who unilaterally determine the direction of the organization.

11/14/2012 9:59:32 PM | 0 comments

As I discussed in my first blog, starting an Observation Unit (Obs Unit) at our hospital has been rewarding, and has been a learning experience. I would now like to share some of the results and consequences. First, we set out and achieved our goals, which were:
  • Decreasing the readmission rate.
  • Increasing efficiency and creating a release valve for a busy inner city ED.
  • Decreasing one day stays (they went from the high 30% range to 20%).
  • Decreasing the average length of stay.

The new Medicare penalty for a 30 day readmission applies to readmissions for heart attacks, heart failures, and pneumonias. As part of this new policy, hospitals will be penalized if patients with the same diagnosis are readmitted within 30 days. By definition, an Obs status equals an outpatient visit, thus an Obs status is a way for the hospital to avoid potential penalties. In our experience, we gained efficiency but lost potential revenue and became victims of our own success.

11/12/2012 11:57:26 PM | 1 comments

Healthcare is bankrupting this country. The truth is, emergency physicians are as much a part of the problem as any other provider, health plan, or patient in this country. Many emergency physicians over-order scans and tests, practice defensive medicine, over-utilize consultants, don’t pay much attention to the cost of drugs and treatments we order or prescribe, and generally spend too much money for too little benefit. I could argue convincingly that we are more effective and efficient than most physicians, especially in light of the difficulties of practice in the ED; but our challenge is not just to dispel the mistaken assumption that ED services do not meet the value proposition. We must simultaneously participate in developing solutions to the cost-effective care conundrum, or the payers and politicians will focus on ways to work around us, or through us.
11/6/2012 6:30:55 PM | 0 comments
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