So, I’m sitting in a restaurant overlooking our local Arizona ice rink (yes, we do have an active hockey establishment in the desert) and watching my son skating round and round at a school event. As I’m watching him, it occurs to me that the circular nature of the ice rink is a good parallel to the Acute Care Continuum. Lately, I’ve wondered about the growing importance of inpatients understanding their discharge instructions and medication side effects; or how and why we need to be concerned and anticipatory in regards to the prevention of readmissions.
The concept of the Acute Care Continuum can often be overwhelming. By dictionary definition, a continuum is “a continuous extent, series, or whole.” I read it as patient-centered care at every point in the healthcare process. As an individual healthcare provider, at times I have difficulty imagining how I can singularly make a difference in the entire continuum of care. As an emergency physician who manages just one instance of care, it seems even less likely that I can change a patient’s path – helping him or her avoid the rut in the ice and steering smoothly through the process.
Much like my son’s travels around the rink, patients often have a circular journey through the healthcare system. For example, when I see a patient in the ED for a chronic disease such as congestive heart failure (CHF), I admit them to the hospital due to their impending respiratory failure, hypoxia, and for treatment with diuretics and nitrates. At that point, my job is complete; and I can be satisfied with the care I’ve provided and go home. The patient then stays in the hospital for a period of time, is discharged and we, the providers of care, hope the patient will stay out of the hospital and live a happy life. However, all of us understand that this is not really the case. We know the patient will be back with another exacerbation – requiring more medication and hospital bed days, more nursing care, perhaps this time a discharge to a SNF or other type of monitored facility. This is the inevitable spiral of chronic disease.
So what if we, those at the bedside, could intervene? A good place to start would be to recognize that appropriate “treatment” is no longer enough. Perhaps a new way of thinking is required? Appropriate treatment and education may be the new standard. It may not be enough just to recognize that they are in a circular continuum, but we may also be able to strategically educate them on how to skate better. Agree or not, the old style of healthcare delivery will no longer be tolerated – not by patients, their families, the government, the insurance companies, or the majority of your fellow citizens.
Now, many readers are probably thinking this is a bad thing. I would argue the opposite. As much as I need to get my son around the rink safely, I also need to teach him the skills to get around the rink safely on his own.
How can a provider in the Acute Care Continuum begin? Just choose one method. Perhaps it’s a joint discharge with the nurse so you can answer the inevitable questions which arise about medications upon discharge. Maybe you can sit down for an extra 60 seconds to explain the disease process and what to expect. It may be that you educate yourself on alternatives to admission such as SNF, observation status, or hospice and then pass this education along to your patients while they’re in the ED. There are plenty of other options I’ve not mentioned, such as all the innovations in Team Care.
But the point is, just choose one. Help your patients skate through the Acute Care Continuum.
A smooth and integrated future with an Acute Care Continuum seems well within reach, especially considering these days a city in the heart of the desert now has a professional hockey team calling it home.