10/20/2017 | RESOURCES

A Physician (Geriatrician) and Practice Director

For a hospital-affiliated Geriatric Medical House Call Program

The Geriatric Medical House Call Program had a patient in her 70s who was recently treated in home for pneumonia. While the pneumonia had stabilized, the patient had a lingering cough (as is normal for pneumonia patients). For loved ones, a lingering cough may cause concerns. An out-of-town family member grew concerned after observing the cough and dialed 911 to have the patient sent to an Emergency Department (ED, ER) at a different hospital than the one affiliated with the House Call Program.

During the hospital ED admission process, the patient was described with a generic chief complaint of “cough” in the Admit Discharge Transfer (ADT) notes. ENS sent a notification to the practice director of the House Call program that allowed him to be aware of a potential readmission case. Using the HIE’s query portal, the practice director retrieved the diagnostic report from the x-ray that had already been conducted at the admitting ED. Diagnostic x-rays showed no new complications and suggested that the original pneumonia had begun to subside.

This available data suggested to the Practice Director that the original pneumonia had not returned and the coughing was benign in nature. Subsequently, the Practice Director spoke with the treating physician at the ED to discharge the patient after explaining the prior history to the treating physician. The ED treating physician agreed and then discharged the patient; thus, an unnecessary inpatient admission was avoided.

We are “astounded every day that this thing [ENS] even exists,” said the Practice Director.

Practice Directors at House Call programs often get ENS discharge notifications, schedule their in-home follow-up visits, see the patient within 48 hours, and realize that their patients were prescribed a medication at the hospital that they have no business being on (adverse reactions w/ existing meds, etc.). If ENS didn’t allow them to see their patients so quickly after discharge, severe (avoidable) adverse effects could materialize based on these improper medications.

Other benefits of ENS include the following:

  • As a home care practice, the “Discharge to” field in ENS notifications is immensely valuable to find out how to conduct follow-up visits. 
  • Healthcare team members and stakeholders of care use ENS notifications to identify frequent flyers with greater certainty.
  • CMS requires them to run quality outcomes measures on their patients–ENS greatly facilitates their ability to measure readmission rate and comply with CMS.

Workflow Integration

  1. Lead geriatrician and one support staff receive all notifications (via Direct) at all times.
  2. They forward all notifications to the on-call physician for that week as well.
  3. If they receive an ENS notification indicating one of their patients has been admitted to an ED outside of their affiliated hospital:
  4. The Practice Director logs into the HIE’s query portal to obtain any information on the current hospitalization that may have already been submitted to the HIE: lab results, imaging reports, etc.
  5. The on-call physician for their program contacts and speaks with the on-call ED physician at the treating hospital, and they discuss medical histories, recent labs, imaging results, procedures.

 

Part of the overall goal is to divert unnecessary inpatient admissions. If they receive an ENS notification indicating one of their patients has been discharged from a hospital, then the support staff checks Direct inbox for notifications on discharges, i.e. every Sunday and Wednesday. Subsequently, the practice nurse/NP will work to contact patient, and schedule a home visit within 48 hours after discharge.