A Better Way to Manage Acute Care

A few weeks ago, we received a letter from a patient who had recently been treated at one of our integrated acute care locations at Somerset Hospital. The patient had come to the emergency department and was ultimately admitted to the hospital. The letter detailed how grateful he was that the same physician assistant who had seen him in the ED also treated him in the hospital. The patient didn’t have to tell his story over again to a new provider once he’d been admitted, and there was no confusion about any of the care he’d just received. Handoffs, which normally occur between different groups, one in the ED and the other on the hospitalist side, have gone from riddled with delay and prone to communication breakdown, to smooth and uneventful.

This is the kind of patient care our new integrated acute care model is designed to provide. Hospitals and health systems throughout the country are thinking in this direction. They are thinking about how to provide better patient care across the continuum, and about how to reduce the kinds of errors and redundancies which have historically been a challenge when one group within a hospital hands the care of a patient over to another group.

For years, there have been programs designed to reduce those redundancies and errors, software designed to help disparate EMR systems communicate, protocols for admitting and transferring patients between care settings, and a whole industry of accordant processes and infrastructure assigned to help alleviate the problems which inevitably arise from a disaggregated healthcare system.

As a group whose founding partners were all traditionally focused on emergency medicine practices, we know these problems all too well. Our sphere of influence and our ability to solve problems within the hospitals and health systems we’re partnering with has always been limited. In the past, being a forward thinking emergency medicine group meant thinking about management processes which occurred outside the walls of the emergency department. We considered questions like how to improve communication with the hospital nursing staff, or how to speed bed assignment.

With integrated acute care, every single one of those traditional challenges is within our power to solve, and others disappear altogether. Our program unifies management of patient care across the acute care spectrum, from the time a patient enters the ED, through to a hospital admission (if they are admitted), and following through to post-acute care, whether that’s a nearby skilled care facility or with a home healthcare aid.

Unlike other groups who simply manage both the hospitalist side and the emergency department and call it “integrated,” USACS is actually building a fully integrated management and care structure from top to bottom, start to finish.

We collaborate with the same advanced practice providers (APPs) throughout the hospital, allowing us to flexibly re-assign or re-direct staff as needs shift, and there is a single medical director at each location responsible for both the emergency department and the hospitalist program. Dr. Dan Geary serves as medical director for Somerset Hospital, while Dr. Donna Balewick is medical director at Indiana Regional. Both of them, as well as a dedicated team of USACS nurses, physician assistants and physicians, have put in the hard work and long hours to help pioneer this program.

In addition to unified medical directorship, a new integrated acute care nurse works with physicians to coordinate patient care and ensure the patient’s concerns are addressed throughout their journey. Having this continuity of care from emergency department through to the hospital is one of the primary benefits cited by patients in their feedback to the hospital.

Meanwhile, evidence-based protocols can be implemented not just within the hospital, but even once they transition to post-acute care, meaning we can have a direct line to reducing re-admissions like we’ve never had before.

Finally, for our health system partners, there is a single point of contact. In the past, hospital administrators often played mediator between their EM and hospitalist groups, negotiating how to solve disagreements over orders, admits, you name it. Now, with our integrated acute care model, administrators are no longer stuck in the middle. It is a huge headache completely off their plate.

Our first pilot program rolled out at Somerset Hospital in Somerset, Pennsylvania in January this year. Our second pilot launched in August at Indiana Regional in Indiana, Pennsylvania. At both locations, we are starting to see amazing results, both in patient outcomes and in core hospital metrics. The improvement in metrics is only made more stunning with the knowledge that our program replaced one of the country’s largest and most well-known hospitalist groups.

Left Without Being Seen rates have fallen from 1.2% to 0.3% averaged over the five months since implementing the integrated acute care model. Over the same time period, Arrival to Provider time and Length of Stay for Discharged Patients both saw significant drops, while the average Length of Stay for admitted patients has fallen by 18 hours. These capacity improvements are an improvement for the hospital and have led to a boost in patient satisfaction. The changes are also starting to have a strong positive impact on the hospital’s public perception within the community.

As we move forward into other health systems, USACS is at the forefront of helping our partners deliver better, more efficient care, which means reduced hospital stays for patients, improved communication throughout the care continuum, increased patient satisfaction and ultimately better care overall for the patients we serve.