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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As the nexus between the outpatient and inpatient care delivery systems, the Emergency Department is increasingly the gatekeeper of inpatient admissions.

Although the complexity of ambulatory care patients is increasing, the result of economic pressures on primary care physicians is a schedule that causes the older and sicker patients to receive only  the same amount of physician time as the younger, healthier patients. As ambulatory care providers have less time to thoroughly assess the patient and arrange for direct admission, patients are increasingly sent to the ED.  The result: now greater than half of all inpatient hospitalizations are originating in the ED.

Given this dynamic, it is not surprising that the number of ED visits has been increasing significantly.  Over a recent twelve year period, visits have increased by 35%-- from 94.8 million in 1998 to 127.2 million in 2010.

5/8/2012 9:29:05 PM | 2 comments

I try to make it a point to find medical blogs that stay up to date on the latest emergency medicine developments. You may be especially interested in two articles. One discusses strategy and technology architecture issues associated with the future development of EMR. The other is a study about how to curtail the overuse of the ED by frequent users.

What is happening with the $19 billion stimulus aimed at modernizing EMR?

In this Forbes article by contributor Dave Chase, Health Systems Spending Billions to Prepare for the “Last Battle”, Chase talks about how designers of the next generation EMR will have to create a system that is more nimble, affordable and person centric. He explores how health systems are currently working to meet this future amidst the many challenges. Consideration is given to how a constantly changing technology architecture that creates a new software playing field every 5-10 years could impact this development.

5/4/2012 12:41:50 AM | 1 comments

Should the title of this blog strike fear in the hearts of emergency physician specialists? There is an erroneous urban legend which says the Chinese character for “crisis” is composed of elements that mean danger and opportunity. While the legend may be incorrect, the notion sometimes has truth behind it. Is that the case with PAs and NPs working in EDs?

The fact is that producing emergency medicine residents at the current rate, we will not be able to fill the number of open emergency department positions in the United States -- ever. That certainly seems like job security for those of us who are Board certified. I am certainly glad I have kept my Boards current, but how will that solve the man/womanpower shortage in EDs that we face now and in the future?

5/1/2012 11:28:56 PM | 1 comments

When I started working as a hospitalist in 1998, there were only a handful of such jobs available in the country. Hospitals were either thinking about starting a hospitalist medicine program or trying to decide if they even needed one. I started working as a hospitalist right out of my residency at Cook County Hospital outside of Chicago (which was an experience in itself). I was full of energy and knowledge, as I had just taken my ABIM boards, and thought I could handle anything. Well, my first few years were very humbling. I found out I had a lot to learn about medicine and life. It was a challenge to try to navigate patients’ end of life issues while figuring out if I really even wanted to be a hospitalist for the next 20+ years.  

I used to get comments from the PCPs that the hospitalist was just a highly paid resident, because if you were a real physician, you would take care of the patients in the clinic as well as when they were in the hospital. Or that a hospitalist was just a temporary phenomenon that would not last. And there was always the comment that hospitalists could not know a patient they were seeing for the first time as well as a PCP who had taken care of the same patient for years.

4/26/2012 10:44:28 PM | 0 comments

Steve Jobs knew that the key to Apple’s success was simplicity.

Apple products are painstakingly designed for simplicity. Updated Apple products are always better than their predecessor. If you question this, visit an Apple store at the release of the next iPhone or iPad.

Quite the opposite is true in the EMR-healthcare arena. The result: hospital executives are pressured to buy systems that “fit” into their existing IT platform regardless of physician usability. My intention is not to pile-onto the existing discussions about the 15-30% drop in productivity when EMRs are implemented. Unfortunately, I can attest to those numbers within our own organization (thus, the development of the scribe program). 

The merits of the HITECH Act, the EHR Federal Mandate, and The Stimulus Package have been greatly discussed. I could argue that EMRs do not provide better patient care.

I want to know who will save physicians, hospitals and patients from the existing, pathetic breed of EMRs available today?

4/24/2012 7:55:22 PM | 0 comments
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