Transcript Document

Bridging the Gap Between Routine Primary Care and Urgent Care
A teaching hospital of Harvard Medical
School
Scot B. Sternberg, MS, Candace Reynolds, RN, Katherine Chiulli, RN,
Kim Ariyabuddhiphongs, MD, Louise Mackisack, MA, Vasudev Mandyam, MD
Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
Problem:
BIDMC’s HealthCare Associates (HCA) is an academic adult
primary care practice – over 41,000 patients and 100,000 visits
per year.
A large number of “episodic" patient visits, for acute complaints
including shortness of breath, dehydration, and cellulitis.
There had been no infrastructure to provide acute treatments in
the clinic and potentially bypass an Emergency Department visit.
Objective:
Develop an Acute Treatment Service (ATS) within HCA to provide
the right care at the right time.
Treat low-acuity patients who may otherwise need to be sent to
the ED.
Continue to expand services and treatments offered, to progress
towards capturing a wider array of conditions and acuity.
Description of the Intervention, including context
 Identified three treatments to provide: IV fluids, IV antibiotics,
and nebulizers.
 Implementation included retro-fitting of existing space; providing
enhanced training for nursing staff; setup of on-site medications;
standardized treatment and discharge plans.
 Nursing staff provides treatments, overseen by a physician
provider.
 Developed a database to measure and track ATS interventions,
disposition, and time spent. Patients discharged home are also
tracked for 7 days following the visit for any subsequent ED visit
and/or hospitalization.
The
Results/Progress
to
Date:
Findings to date:
HCA Acute Treatment Service Apr-Jun 2014 July-Sept 2014 Oct-Dec 2014 Summary
Total Visits
33
24
37
94
Treatments
IV Fluids
16
16
20
52
Nebulizer
17
7
16
40
IV Antibiotics
1
1
2
Disposition
Home
30
21
33
84 89.4%
ED/Home
1
2
2
5
ED/Inpatient¹
2
1
2
5
Outcome 7 days later²
Home
30
22
30
82 92.1%
ED/Home
1
3
4
ED/Inpatient¹
1
2
3
¹ED and then inpatient or observation
²Outcome within 7 days for patients who were discharged home from ATS or ATS/ED
Key Lessons Learned
 Patients who have accessed ATS have received it very favorably.
 Data shows HCA can offer these acute services integrated into
the primary care setting using existing resources and can avoid
unnecessary ED visits.
 Multidisciplinary debriefs and case reviews highlight
opportunities to streamline care and broaden utilization.
Next Steps
Continue to monitor utilization, discharge, and 7-day outcomes
Standardize discharge instructions and follow-up protocol
Apply QI principles to continuously re-evaluate and improve the
quality and process of acute care delivery
Expand potential diagnoses and treatments available by ATS
¹Special recognition and acknowledgement to the HCA nurses who staff the ATS, including Anne
Bassler, RN; Arvetta Boykins, RN; Kathy Chiulli, RN; Melissa Cote, RN; Sue Dinneen, RN; Michelle
Fiorenzo, RN; Janet Greene, RN; Cathy Ivkovic, RN; Barbara Luker, RN; Maureen Mamet, RN; Deb
Schissler, RN; Tarsha Soares, RN; Kristine Sullivan, RN; Francine Theberge, RN; Jan Woodruff, RN
For More Information, Contact Vasudev Mandyam,, MD/ [email protected]