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For example, he says, in addition to adding weekend services to speed care and reduce lengths of stay, JFK added a second CT scanner to speed imaging. It also created multidisciplinary rounds, including respiratory therapists and pharmacists for every patient.
And JFK is streamlining and narrowing the variation by which doctors treat heart failure patients, and for patients who present in the emergency department with heart issues, there are protocols that call for a cardiologist to be present within the first 12 hours.
"If we work harder during the discharge to make sure the patient is educated, and understands medications, there's a higher likelihood of compliance," Oser says.
"We can probably safely treat and care for the patient and discharge them in [fewer] days than we formerly did because of a less disciplined or less consistent practice, and we can minimize the likelihood that they're going to be readmitted to the hospital in the next 30-60 days."
St. Bernardine's Barron says that at his hospitals, the project includes nurse practitioners making daily phone calls to certain Medicare beneficiaries with chronic disease up to 30 days, and make sure medications are appropriate and that they're able to see an appropriate physician quickly.
"Sometimes the medications the hospitalist gives are not the same as what's on their formulary with their insurance plan, or what their primary care physician or cardiologist wants them to have," Barron says. "Sometimes they don't get in to see their doctor immediately after discharge, and things can get mixed up."
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