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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Recently, the Report on Medicare Compliance (from Atlantic Information Services) published an opinion article about the use of scribes in healthcare.  The premise of the article was that hospital executives and physicians should re-examine the benefits of scribes because compliance risks grow when scribes are allowed to make entries into electronic health records.  Furthermore, the article questioned the gains in physician productivity from scribe utilization.

Are these authors practicing physicians themselves?  Do they understand the growing clinical pressures and demands placed on healthcare providers today? Have they ever used an EMR in an acute care setting (like an ED) where providers are expected to see upwards of 3 patients per hour?  My guess is that they have not.

I believe that the authors are not only misinformed, but that their article will hinder the advancement of EMRs and the modernization of the healthcare workforce. 

6/19/2012 11:54:00 PM | 0 comments

Under the current siloed, discrete process of delivering medical care, each physician that participates in the care process is driven by different and sometimes conflicting goals.  Emergency physicians are driven to rapidly diagnose, provide initial management and prep patients for rapid movement from the department.  The goal is to provide the care necessary to as rapidly as possible free up the emergency department bed for the next patient.  They are working in a context of a continual flow of patients and limited time and resources.  

Hospitalists want to make sure that every admission is necessary and directed to the correct inpatient bed, that the patient work-up includes the information necessary to determine all necessary next steps, that admissions are minimally disruptive to their scheduled work flow, and that hospitalized patients receive the care necessary to minimize their length of stay while providing adequate recovery to also minimize the likelihood of readmission. 

6/14/2012 7:09:51 PM | 3 comments

There is a classic episode of  “Laverne and Shirley” where they are marching around their apartment chanting “We must, we must, we must decrease our bust.  We must, we must, we must decrease our bust.”  If I recall correctly they were attempting to transform themselves into the role of men, so they could compete for some job or new role at work.  If you aren’t familiar with Laverne and Shirley, they were two progressive, iconic women who lived together in an apartment in Milwaukee and worked at a brewery during a time when this was not commonplace for women.  I loved this show when I was a young girl, because it represented for me – women who were always pushing the envelope and instigating change.  Whenever they tried to be someone they weren’t or do something that went against their core values, it completely fell apart, but in a comedic way, leaving the viewer in a fit of laughter (i.e. stiches). 

Terms like ‘change’ and ‘decrease’ are very relevant to what the healthcare field is going through right now. Yet the stakes in this change are so high and the need to decrease inefficiency so important, not even Laverne and Shirley could make this funny.

6/11/2012 9:48:40 PM | 0 comments

The move toward care integration is intensifying, and some of the solutions I see emerging right now might have looked like science fiction a few years back. I don’t think anyone envisioned so many departments coming together under one umbrella in a hospital setting and working with agile outside entities such as a Federally Qualified Healthcare Center (FQHC). But scenarios like this are being fueled by both the government and hospitals.

The Federal government sees cost savings associated with integration and uses incentives such as bundled payments to bring departments together. With the budget crisis and patient boom, hospitals are harnessing this power of collaboration and working to build the seamless transfer of care between departments.

Imagine this: an integrated team that includes the ED, hospitalists, intensivists, primary care physicians (PCPs) as Chronic Disease Management specialists, and even post-acute care done though a FQHC. FQHCs are publicly-funded health clinics that provide primary care services for underserved patients. They also provide, or have an agreement with another organization to provide, dental services, mental health services, as well as hospital and specialty care. FQHCs are quickly entering the healthcare landscape as they gain financial resources. The Affordable Care Act in 2010 included $11 billion for FQHCs over a period of 5 years. Considering this influx of money, you can understand why FQHCs are gaining prominence and emerging in the hospital setting.

6/6/2012 9:57:23 PM | 0 comments

The number of PAs in the United States is rapidly rising. According to the National Commission on Certification of Physician Assistants, the number of certified Physician Assistants has increased 75 percent in the past eight years from 48,000 to 84,000. In addition, the Bureau of Labor Statistics reports that the employment of physician assistants is expected to increase 30 percent between the years 2010 and 2020. Considering the increasing physician shortage, the 35% increase of the ED patient population over the past 12 years, and the potential that this increase could potentially double in some locations over the next decade, I wonder if in the future PAs could help fill the need in the Acute Care Continuum that Dr. Curry described?

PAs as well as nurse practitioners can play a key role within the physician led team. PAs and NPs work in EDs on the front line in Provider in Triage (PIT) programs, in the Fast Track areas, in the Main EDs, as well as in roles caring for acutely ill and injured patients and in our ambulatory and urgent care centers. Hospitalist groups also utilize PAs and NPs in the inpatient hospital setting. PAs and NPs are truly involved in all aspects of patient care that make up the Acute Care Continuum.

6/1/2012 1:34:05 AM | 0 comments
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