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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Discount the posturing of politicians reaching for the healthcare issue that will attract attention and garner votes. Set aside the drama of the Supreme Court’s proceedings to determine the constitutionality of recent health care reform. Beneath that is something much more important. Don’t look at what politicians are saying, but watch what healthcare providers and insurers are doing.

Individuals, hospitals, insurers and others who are responsible for actually providing health care have already decided what they need to do. They are not waiting for the government to solve the health care crisis of the United States. During the debates that preceded the enactment of the Affordable Care Act, the providers and insurers saw the ugly and disjointed aspects of the American healthcare system : lack of end of life care for the burgeoning population of baby boomers, medical technology that seems to have no economy of scale, and the inability of the system to address wellness to reduce costs. In short, the horrendous expense without attendant increase in quality has been made apparent.

Most of those who understood the issues concluded that the current system is not sustainable. If we continue on this path, we will bankrupt the country. We simply can’t afford to have 40 million or so people without health insurance. Cost shifting their medical expenses onto the tax payers and private insurers has reached its limit. And, oh yes, don’t forget the national debt that must be paid down somehow.

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4/17/2012 11:05:37 PM | 3 comments


Mobile technology, and specifically the mobile phone, has become the new global platform of computing. This is creating significant sociological changes that will greatly impact the practice of healthcare. The unprecedented computing power available to billions in their coat pockets can be leveraged to improve medical practice and consumer health. However, the explosive growth of this modality also creates the potential for growing pains.

Because healthcare providers have a disproportionately higher rate of smartphone ownership, these devices are now increasingly finding their way into the highly regulated environment of hospitals and clinics. This has the potential to threaten patient privacy and the security of information, which are governed by Federal laws such as HIPAA – and violations already have made headlines with multimillion dollar fines.  Despite this risk, the majority of hospital Information Technology departments don’t even have robust mobile device use policies. 

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4/13/2012 5:09:44 PM | 0 comments

Here are some interesting articles and events related to the Acute Care Continuum:

  • Webinar: Achieving ED-Hospitalist Integration - CEP America (4/19/12)
    Emergency physician Jeffrey Bass, MD, and hospitalist physician Denise Brown, MD, will discuss how the relationship between the ED and hospitalists can improve and the subsequent impact that can be felt throughout the hospital. Registration is still open.
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4/12/2012 11:31:20 PM | 0 comments

Patients have been arriving at the doors of Emergency Departments in increasing numbers over the past decade, and this trend will only grow in the future. I believe there are five key factors that suggest every ED should brace itself for a never-ending rush hour.

As the CEO of a physician group that provides medical care to over 4 million patients per year, I have the opportunity to study in great detail the trends in patient acuity, demographics and yearly visits in more than 80 emergency departments and watch the monthly variations.  I recently asked staff, with the assistance of our in-house biostatistician, to project the ED patient volume in the future based solely on the incremental increase in the past patient volume in the past decade, while making no other assumptions.

The results were startling. If nothing changes, the “people curve” of patient visits to the emergency departments we serve will rise dramatically by 2020. These futures are merely a projection of actual growth rates from the past decade and they showed a doubling in ED patient volume between 2000 and 2020. At a hospital in California’s Central Valley, for example, we saw the volume of ED patients rise from 50,000 in 2000 to 70,000 in 2010 and they are expected to grow to 95,000 by end of this decade.  Most noteworthy in the analysis were the number of hospitals with ED visits that are projected to exceed 100,000 patients per year.

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4/11/2012 6:13:50 PM | 3 comments

Thinking about this dynamic time around us in The Acute Care Continuum has made me reflect on my years as an attending emergency physician at a hospital in Southern California.  It does not seem so long ago (though it has been 30 years) that I started my career and we had only 27,000 patients coming through our doors each year.  This year that number will reach more than 90,000 with only a modest increase in the available ED space, which was designed 30 years ago for at most 50,000 visits per year.

About a decade ago the ED where I work implemented Rapid Medical Evaluation® (RME).  This has significantly improved our time to provider (TTP) in the ED as well as our patient satisfaction.  Our TTP went down from well over an hour to about 21 minutes, while patient satisfaction scores went up for both our high- and low-acuity patients.  I remember skeptical nurses and some very pleasantly surprised patients, but ultimately the RME process became routine. We developed the concept of “vertical” and “horizontal” patients, streamlined throughput and created ED virtual space to see more patients.

And more patients came year over year over year. With every new surge in patients we redesigned the RME process, learning what worked and what didn't from other practice locations in our organization. Now we are poised to hit 100,000 patients per year in the near future.

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4/5/2012 11:57:14 PM | 0 comments
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