As the Fifth Annual Kindred Clinical Impact Symposium wraps up, participants came together to make some recommendations for further care of our fictitious patient, Jack, who has many co-morbid conditions and ended up in the post-acute care continuum after being hit by a car while riding his bike, requiring surgery for a broken femur.
After his initial discharge from the acute care hospital, Jack went to a skilled nursing facility, back to the acute care hospital, then to a transitional care hospital and ultimately he was transitioned to home health care. At the current moment, Jack’s home health providers are concerned about his agitated state and resistance to taking medications and exercising.
As Jack continues his journey in the post-acute continuum, CIS participants had some common recommendations for his care:
Kim Warchol has been an Occupational Therapist specializing in dementia for more than 24 years. One minute of listening to her talk about her field and you can hear the years of experience and passion in every word. But she readily admits that she wasn’t prepared to deal with cognitive impairment when she first started practicing.
Her “aha!” moment came through the work of Claudia Kay Allen, MA, OTR/L, FAOTA, which completely changed her perspective from focusing on the limitations of patients with cognitive impairment to focusing on uncovering what they could do. She hasn’t looked back since and, she says, she is no longer “leaving these vulnerable individuals to fend for themselves.”
Would you get on a flight if there were a 1 in 100 chance of the plane crashing? Healthcare is at a one percent rate of adverse events. It used to be 6 to 18 percent, so we’re making progress.
What are three things we can we do to keep people safe? Create and use checklists and standardize processes and products.
What is efficiency in care? Delivering the right amount of care in the right place at the right time.
How did one Massachusetts hospital significantly reduce the mortality rate from ruptured aortic aneuryisms? By setting up systems where everyone is trained in the treatment and knows where things are, so staff and clinicians are ready to go at a moment’s notice.
What does “post-acute paradigm shift” mean?
What’s wrong with the U.S. healthcare system?
“A lot goes in and very little seems to be coming out the other side in terms of welfare and satisfaction and extended life”
- Jack Wennberg, founder, Dartmouth Institute for Health Policy
What are care management’s best practices at this early stage in its existence? This question was answered by William Mills, MD, Chief Medical Officer for Kindred at Home and Vice President of Medical Affairs for Kindred’s new Division of Care Management, during a break-out session at Kindred’s Fifth Annual Clinical Impact Symposium.
There’s no doubt that readmissions to acute care hospitals are costing the healthcare system a lot of money, and the patients who cost the system the most might fit a profile like this:
Patients like this typically see anywhere from two to ten doctors regularly. They have no home support, so when a crisis arises, 911 is called and the patient is taken to the emergency room, which leads to a hospital stay eight out of ten times, Dr. Mills said. Rehabilitation and a long-term care stay follow, then home care and then the cycle recurs.
For patients like this, wouldn’t it make more sense to deliver care in the home setting?
Although the posters at Kindred’s Clinical Impact Symposium came from different Kindred facilities and covered different topics, the one thing each had in common was the passion and enthusiasm of the people presenting the projects and information.
While the posters were filled with technical terms and acronyms, the patient was never forgotten and there were often pictures of patients surrounded by their care teams, many having defied the odds for a successful outcome. While it wasn’t possible to cover all of the presentations, we had a chance to talk to the people behind three of them.
Our fictitious patient, Jack, has developed severe diarrhea and is being treated with metronidazole. He is in a skilled nursing facility for wound care and rehabilitation. The diarrhea is not improving and oral vancomycin is started for suspected C. Diff infection. Stool cultures have been sent out.
The stool culture comes back positive for CRE, or Carbapenem Resistant Enterobacteriaceae.
Ruth Carrico, PhD, RN, Associate Professor, Division of Infectious Diseases, Department of Medicine, University of Louisville School of Medicine, led participants at the Fifth Annual Clinical Impact Symposium through the next steps of infection control for our patient, Jack.
Carrico first questioned participants about whether, given his situation, Jack should be isolated. The answer? Yes.
“We must assume that a body fluid out of control is caused by something transmissible until proven otherwise,” she said.
Effective, efficient movement of patients through the post-acute continuum of care is Kindred’s goal. But infectious diseases are unwelcome visitors that also like to make the post-acute continuum of care their home, starting in the acute care hospital and settling in at the various levels of post-acute care settings.
Addressing issues related to infectious diseases today at Kindred’s Fifth Annual Clinical Impact Symposium was Alice Kim, MD, Director of Infectious Disease/Control at Kindred’s Cleveland Fairhill Hospital.
Dr. Kim, who came to Kindred from the Cleveland Clinic with the mission of implementing acute-hospital devised infectious disease plans in the post-acute setting, described the challenges related to infectious diseases in both acute and post-acute care.
NOTE: The following care story is purely hypothetical and was crafted specifically for 2013 Clinical Impact Symposium attendees to use as an exercise in care transitions. Any resemblance to a person living or deceased is coincidental. Future CIS posts may refer back to this fictitious story for reference.
Stacey Seggelke, sees patients with diabetes both in and out of the hospital, and shared her experiences at the Kindred Clinical Impact Symposium. She is a member of the inpatient Glucose Management team at the University of Colorado Hospital and has an outpatient diabetes clinic one day per week.
There has been a steady and significant increase in diabetes over the last 30 years. It affects 8 percent of the population, and it is estimated that there are 79 million people who are pre-diabetic. Even when it is not the primary diagnosis, diabetes impacts the care provided to the person, and Seggelke works with her patients from admission to discharge to make sure that the treatments for other medical issues don’t harm the patient or cause problems related to their diabetes.
Did you know that a pharmacist invented Coca Cola? This was just one interesting fact divulged by Kindred Hospital Division Vice President of Pharmacy James Poullard, who presented this afternoon at Kindred’s Fifth Annual Clinical Impact Symposium.
For Coke lovers, this fact makes pharmacists critical. But more importantly, pharmacists play a crucial role in effective care transitions.
Pharmacy – the science and technique of preparing and dispensing drugs and medicines – has undergone a transformation over the years, according to Poullard.
“We’ve gone from pouring sodas and mixing elixirs to now being the medication expert in retail outlets, and in the inpatient arena,” he said. “There are now post-graduate residency programs and we’ve become an integral part of the patient care team.”
And pharmacists have their work cut out for them.
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