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An Article We Wanted to Share

Posted by Allison on Tue, Jun 30, 2015 @ 07:26 PM

Repeat emergency room visits more common than previously thought

New research suggests that ailing people should be more pushy about getting follow-up care.

Dr. Reena Duseja, lead author of a study on emergency room visits, stands in San Francisco General Hospital's emergency room. No one wants to make a repeat visit to the emergency room for the same complaint. But new research suggests it's more common than previously thought.
The Associated Press
Dr. Reena Duseja, lead author of a study on emergency room visits, stands in San Francisco General Hospital's emergency room. No one wants to make a repeat visit to the emergency room for the same complaint. But new research suggests it's more common than previously thought. The Associated Press

WASHINGTON — No one wants to make a repeat visit to the emergency room for the same complaint, but new research suggests it’s more common than previously thought and, surprisingly, people frequently wind up at a different ER the second time around.

Already some ERs are taking steps to find out why and try to prevent unnecessary returns. A Philadelphia hospital, for example, is beginning to test video calls and other steps to link discharged patients to primary care.

The new research, based on records in six states, suggests patients should be pushy about getting follow-up care so they don’t have to return to crowded emergency departments.

“You need to make sure the next day, you connect the dots,” said study co-author Dr. R. Adams Dudley of the University of California, San Francisco. “You cannot count on the health system to connect the dots.”

It’s also a reminder of how disconnected our health care system is. Chances are, your primary care doctor won’t know you made an ER visit unless you call about what to do next.

And if your second visit was to a different ER, often doctors can’t see your earlier X-rays or other tests and have to repeat them. While more hospitals and doctors’ offices are trying to share electronic medical records, it’s still far from common.

“It’s frustrating. We’re open 24 hours a day and we don’t necessarily have access to those records,” said UCSF assistant professor Dr. Reena Duseja.

Duseja’s team analyzed records from Arizona, California, Florida, Nebraska, Utah and Hawaii, among the first states to link records so patients can be tracked from one health facility to another. Researchers checked more than 53 million ER visits in which the patient was treated and sent home between 2006 and 2010.

About 8 percent of patients returned within three days, and 1 in 5 made a repeat visit over the next month, Duseja reported this month in Annals of Internal Medicine.

A third of revisits within three days, and 28 percent over a month, occurred at a different ER. Duseja couldn’t tell why – if patients were dissatisfied the first time, or traveling, or for some other reason.

Patients with skin infections were most likely to return, followed by those with abdominal pain.

State rates varied a bit, with 6.2 percent of Arizona patients returning within three days compared with 9.3 percent in Utah.

Revisits may be appropriate, Duseja said. Nearly 30 percent of revisits involved hospitalization, suggesting either patients got worse or emergency physicians felt more scrutiny or testing was warranted.

Also, sometimes ERs tell patients to return. In the ER at San Francisco General Hospital, Duseja sees many Medicaid or uninsured patients who have trouble finding a primary care doctor or specialist.

 

Tags: healthcare, emergency

Revenue Cycles and Hospital Management

Posted by Allison Dewan on Mon, Sep 15, 2014 @ 02:12 PM

Revenue Cycles and Hospital Management

Often times one might not associate revenue cycles with hospitals, because hospitals are many times understaffed and lacking resources, thus making revenue cycle management difficult.

But this is constantly changing and hospitals are becoming, and have become, more efficient.

Yes, hospitals are places where patients receive treatment - pretty clear definition. But, when it comes to managing hospitals, one thing always arises and is a key component to most, if not all, decisions made when operating hospitals.

With the new federal mandates, comes more and more EHR implementations, and coming from this is meaningful use and ICD-10 and their associated changes. Some see these changes as burdensome, but with the help of medical scribes, these new changes can actually lead to more streamlining and efficiency, and to better doctor patient interaction.


Despite some hospitals viewing EHRs and electronic charting in general as a hassle, some hospitals are actually profiting more from these changes. Revenue cycle management and financial metrics are important to hospital administrators, and though new changes may lead to new organization and management of health care, as seen in analysis, using EHRs and medical scribes can lead to growing profits. EHRs can clearly be productivity-boosting and especially so when viewing EHR through the lens of patient coordination.

For more info on this click here to see an article by EHR Intelligence.

Tags: healthcare, EMRs, healthIT, patient satisfaction, emergency

Focus on Patient Satisfaction and Improvement

Posted by Allison Dewan on Wed, Sep 10, 2014 @ 04:32 PM

Patient Satisfaction & Thoughts on Improvement

Hospitals can always improve when it comes to patient satisfaction.

Administrators and consultants are always looking for ways to become an even better provider to their patients. With ever changing technology and new requirements for documentation, it can make it even more difficult to achieve high patient satisfaction. As a writer for MedCity News put it, “ I’ve felt that there’s not been enough next-generation tech being applied to the low margin, high volume business of hospital supply management.” Supply chain automation is important to gain higher patient satisfaction, and even though it is often viewed as being the responsibility of the administration, it is directly tied to patient and nursing satisfaction.

  • Supply chain expert Harold Richards explains that thinking about patient satisfaction and supply chain can be compared to ant hill management:“You may have had an ant farm as a child and marveled at the cooperative efforts and precisions of the ants as they went about their daily activities...so it is with the hospital supply chain, full of hard working individuals who run into daily challenges just as ants do. Both rely on excellent systems of communication to get things accomplished. However, ants do not have to deal with bureaucracy, integrating of mismatched systems, missing supplies, and other time-wasting system failures (at least not as far as we can tell).”

The ant farm comparison seems to be on point when it comes to managing busy ER departments and the like. Today more than ever, patients are converging on emergency rooms across the country seeking treatment for their ailments. Resulting from this is - you guessed it- overcrowded ERs filled to capacity and short staffed in many cases. According to the USA TODAY, some hospitals are faced with spikes as high as 12%.

It is apparent that an increase in volume can cause problems, and without proper planning and supply chain management, there could be inefficiencies such as shortage of staff and medical supplies in emergency situations. So, look at hospital management from the ant farm perspective if you will...it might just make it a little clearer...and little more fun to analyze efficiency. Make sure you know what is happening in your ant hill.


Tags: healthcare, healthIT, patient satisfaction, Scribe, emergency

Preparing for Emergency Situations and Health IT

Posted by Allison Dewan on Sat, Sep 06, 2014 @ 03:57 PM

Emergency Preparedness and Health IT Systems  

The Department of Health and Human Services (HHS) has been increasing its initiatives to help providers prepare their IT systems for emergencies. These initiatives are important because there is always a chance for natural or man-made disasters to strike. A National Coordinator, Karen DeSalvo, MD, MPH, Msc and Greg S. Margolis, PhD NREMT-P explain that HHS is making an effort to help providers prepare for potential disasters and to protect data and patients in the event of an emergency: “The question isn’t whether or not we will have another disaster - it is just a matter of when, where, and how severe it will be.”

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Natural disasters can be devastating events, and hurricanes, earthquakes and other storms can cut off electricity and internet connection which can lead to crisis situations in hospitals. That is why it is key to follow HHS activity and initiatives to prepare for emergencies.

Examples of HHS efforts of preparation are detailed below:
  • First project is a single website that aggregates real-time data from Twitter to identify trends related to public health and incidences of disaster.
  • Second project is another website that is still being developed, and it will include an interactive map to highlight the number of Medicare beneficiaries reliant on electricity on a given zip code level. This map will tie directly to data from the NOAA to warn hospitals and other providers about storms approaching that may cut power at their locations. 

To see more information on HHS efforts to take on EHR and data disaster planning click here.

Tags: healthcare, EMRs, healthIT, Scribe, EMR, emergency