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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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.

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

Perspectives on The Acute Care Continuum gives a tip of the cap to Myles Riner, MD, for his prodigious year of blogging, including our number 2 most popular blog from 2012:

One of the topics that attracts a lot of attention when emergency physicians and those interested in ED practice management get together to discuss how emergency medicine can remain relevant in, and become integrated into, the new health care reform and value based purchasing paradigms, is the concept of care coordination.  In theory, since the ED is linked to such a wide range of diagnostic testing resources, care facilities, and providers, and sits at the intersection of outpatient and inpatient care for many of the patients who are hospitalized:  emergency physicians ought to be able to play an important role in the coordination of care, both for the acutely and for the chronically ill.  In practice, many of the systems support structures that need to be in place to facilitate this role have often been ignored or neglected, or deferred on the assumption that they will be addressed with the adoption of the electronic medical record.  

If emergency physicians and EDs are going to assume the role of master care coordinators (something that family physicians staffing the medical home might consider within THEIR scope), they are going to have to define this role carefully, invest in the systems and staffing to support it, and integrate the concept into everyday practice.  Until now, few payers have been willing to pay for this service, and few hospitals and ED groups have been willing to invest significantly in the systems and staff to support it.  Suddenly, care coordination is the latest buzzword, and the presumptive salvation for what is often perceived as a frequently too expensive and often inappropriately utilized drain on the health care system:  the ED as poster-child for ‘the ‘failure of health care’.

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5/29/2012 8:34:13 PM | 0 comments

Here are recent news items that address trends within the Acute Care Continuum in a colorful and striking manner. One makes the claim that, aside from the patient, the entity most in need of emergency care is the ED itself and calls attention to four solutions. The other is a documentary film about an Emergency Department that also describes larger issues effecting the system.    

Emergency Care for the ED

This article in HealthLeaders points to a 2007 report by the Institute of Medicine that calls the ED a “growing national crisis”. Author Joe Cantlupe touches on many subjects previously addressed in this blog, such as the importance of Urgent Care Clinics, while highlighting four areas of opportunity for future success: taking pressure off the ED, EMR in the ED, frequent fliers, and collaboration with competitors.

Excessive pressure on the ED, in particular, has long been recognized as a major barrier to care and led to the creation of Rapid Medical Evaluation®(RME). It is clear in today’s environment that optimizing the operational efficiency of the ED is a necessary and critical component in ensuring that the best possible care is provided to the greatest number of patients; and RME is one of the tools that can be used to meet the ED’s needs.

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5/25/2012 1:36:28 AM | 0 comments

In the United States many people feel it is their God given right to sue anyone, anytime for anything. Whether you are successful or not may be another story. So what are the cost implications for healthcare in the United States? Few other developed countries rely upon this method for resolving malpractice issues. What is the cost-benefit equation? To protect themselves, American physicians practice what is called defensive medicine designed to ward off the attacks of plaintiff’s attorneys. There was a recent study which concluded that the additional cost for defensive medicine in this country was only about 2.4 percent for 2008. That is a very low number if you have anything to do with healthcare, but this is at least a number that someone has come up with to quantify the cost.

If I were an attorney (and I am not), I would argue that the value of malpractice cases are many: injured parties should be compensated in some manner for material loss of work, comfort and pain and suffering; expenses for rehabilitation and subsequent health maintenance should be paid by the injuring party; attorneys who take on these cases must be compensated for their diligence; cases won by defendants act as a deterrent to further injuries to patients and improve the quality of health care; and whether there is fault or not should be decided by an independent analysis of the case-like a jury.

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5/22/2012 11:34:53 PM | 1 comments

We are at a critical juncture where the collaboration between emergency physicians and hospitalists is imperative for a hospital to achieve financial success in the future. These two hospital based specialties touch almost every one of the hospital’s entire patient population of hospital admissions each year. Yet there has in the past been an inherent conflict of interests in their clinical practices based on the drastically different priorities they each must manage.

This is no longer the way we can do things; there is a new paradigm of practice for both of these physician specialties. The integration of the clinical practices of emergency physicians and hospitalists is accelerating rapidly as hospitals increasingly seek shared financial and operational responsibility for patients and performance metrics across the Acute Care Continuum. As the healthcare crunch to reduce costs and increase revenue builds, perhaps Ben Franklin summed it up best when he said, “We must all hang together, or assuredly we shall all hang separately.”

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5/17/2012 9:39:10 PM | 2 comments
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