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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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

Welcome to our blog. The focus will be on the integration, management, and operational performance of the healthcare providers who are responsible for patient care and experience within acute care hospitals. My goal is for the blog to engage, inform, and serve as a vehicle to share ideas and thoughts among all stakeholders and healthcare professionals about a topic we simply call the "Acute Care Continuum."

In particular we will focus on the physician specialties and hospital departments where care for acutely ill and injured patients is provided – including the emergency department (ED), inpatient services, and post-discharge urgent and ambulatory care (UAC) provided in the 30-day window defined by CMS...

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4/3/2012 11:47:18 PM | 0 comments
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