Managing the Continuum
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When Mayo Clinic began testing its video- and e-consult program, it immediately lessened many patients’ inconvenience with no change in the quality of care. If a PCP would like a specialist’s opinion on a patient’s condition, he or she can e-mail the specialist for advice—and the specialist can access all of the patient’s medical information via the EMR. If the specialist needs more information before making a determination, a Skype consult can be scheduled. If the specialist feels the need to see the patient in person, that can be arranged as well.
“We triage; so instead of everyone getting referred, we can do it virtually without the patient’s life being disrupted,” Simmons says. “E-consults are really neat. I love seeing patients, but if I can add value through the primary care physician without inconveniencing the patient, that’s better all the way around.”
Saint Luke’s care coordinator program also saved time in a number of ways. The hospital decreased the time from physician discharge order to actual discharge from 167 minutes to 110 minutes. It was also able increase the efficiency of its nurses by analyzing processes when it decided to create the care coordinator position without adding any full-time employees.
“We organized the work in a more efficient manner and assigned the right people to the right job,” Thaker says. “We looked at what people were doing before and determined what is non-value-added work and decided not do that anymore.”
The care coordinators also improve patient safety by making the medication reconciliation process more accurate. Since the program began, medication reconciliation has increased from 83% to 95% during admission and from 86% to 98% during discharge.
“Little things like that look like a gain that’s not financial, but it’s a gain the patient and the family will appreciate,” Thaker says.
And that patient-centric approach to care is what managing the continuum is all about.
“This is a very important subject and if it was solved anywhere around the country it wouldn’t be such a hot topic,” Simmons says. “But we need to keep talking about it because we haven’t adequately addressed the need.”
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