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. 

Emergency Physicians Are from Mars, Hospitalists Are from Venus

9/13/2013 8:13:06 PM | 1 comments

Much has been written about the communication disconnect between emergency physicians and hospitalists. On this subject, I feel I have unique insight; and that's because I'm an emergency physician married to a hospitalist.

As you might expect, our dinner table conversations sometimes revolve around medicine and work:

Matthew: (serving up twice-reheated leftovers) Late again, honey? This is the third day this week.

Shirley: Well, your friends down in the ED are killing me. They dumped three admissions on me right at the end of the day.

Matthew: Yeah? Well, you have no idea what it's like to have an overflowing waiting room and one patient threatening suicide while another one codes — all the while trying to disposition your other patients and keep the department moving.

Shirley: Well, if your guys in the ED had done half the tests they were supposed to, I'd have been home three hours ago.

Taryn: (age 7) Hey, why are you guys always talking about work?

So there you have it. Emergency physicians and hospitalists — even couples — view the Acute Care Continuum through vastly different prisms of experience. Neither viewpoint is right nor wrong, of course. So why does it matter?

First, and most importantly, it speaks to patient care. The closer ED physicians and hospitalists work together, the safer and more effective our care will be.

Second, with the realities of healthcare reform upon us, factors like turnaround times, length of stay and patient satisfaction truly impact the hospital's bottom line. Volumes will likely increase. Reimbursement? Probably not. There's an urgent need for efficiency, better transitions of care, and a seamless patient experience across the Acute Care Continuum.

So what can be done? Well, take it from me, a lot of the advice you hear about relationships also applies to the hospital setting. Stuff like:

Seek First to Understand, then to Be Understood

Hospitalists and emergency physicians work in vastly different environments, and this sometimes creates competing priorities.

ED physicians need to turn around their cases and get their patients admitted before the waiting room starts backing up and the department comes to a grinding halt. Meanwhile, hospitalists are scrambling to coordinate patient care with consultants, case managers, social workers, family members and other key players.

Because our work environments are so different, our workflow is also very different. Keeping these realities in mind can help us avoid taking conflicts personally.

Talk About Your Expectations

Whether we're talking about household chores or patient handoffs, it's important for both partners to be on the same page. In the hospital, this might mean agreeing on consistent workups for certain diagnoses and standardizing treatment plans and bridging orders. It's also a good idea to create a handoff plan that specifies exactly when the hospitalist will be called and what information will be communicated.

Respect Boundaries

As in a relationship, schedules don't always match up at the hospital. Emergency physicians work set shifts. Hospitalists work until the work is done. This can lead to conflicts if a patient needs to be admitted right as either person is about to go home. Have an agreed-upon game plan to handle admissions during all times of the day. For instance, the admission process and communication could be very different at 8 a.m. compared to 8 p.m.

Make Deposits in the Emotional "Bank Account" 

You never know when you'll need to ask your counterpart for a little leniency, so make "deposits" of goodwill when you can.

Maybe that means the emergency physician sometimes goes the extra mile to work up a patient and get more testing done in the ED. Or maybe the hospitalist accepts a little less testing when the ED is overwhelmed and agrees to finish the work up on the floor.

Keep the Romance Alive with Regular Dates

When both partners are busy and stressed out, it's especially important to take time just for the two of you. Regular meetings between the emergency department and hospitalists can strengthen relationships and provide opportunities for problem solving.

It is no longer acceptable to have an us-versus-them mentality between our specialties. We must function as a well-oiled machine, or else the patients and the hospital will suffer. Regularly scheduled meetings are the new reality. It is here that conflict will be resolved and planning will take place.

Creating harmonious relationships across the Acute Care Continuum takes time, effort and understanding. But it pays off in better patient care, faster turnarounds, and more financially stable hospitals.

And on a personal note, it could mean the difference between delicious barbecued fillet mignon and twice-reheated meatloaf for dinner at the Stilson house.

[Image credit: "Solar system planets size comparison" by lsmpascal licensed under CC BY 3.0.
 



Comments
Jodi/Today's Hospitalist
Great article. Nice to know that ED and hospitalists can get along both in and out of the hospital :)
9/18/2013 11:23:23 AM