Defragment your CV care by working together
August 1, 1998 4 minutes read
Focus on utilization management
Defragment your CV care by working together
Emory-Henry partnership helps patients recover
Two nurses, one from a teaching hospital and another from a community facility, collaborated earlier this year on a study to follow patients after their cardiovascular procedures and identify opportunities for tertiary center-community cooperation.
Christi Deaton, RN, PhD, assistant professor at Emory University's Nell Hodgson Woodruff School of Nursing in Atlanta, presented an educational program about patient outcomes at nearby suburban Henry Medical Center last spring. As a result of her talk, she and Sherron C. Kurtz, RN, MSA, director of perioperative services at Henry, began to discuss a collaboration to determine patient outcomes after cardiac catheterization and revascularization procedures.
"Our goal was to find out what happened to cardiovascular patients once they'd been referred to tertiary centers," says Kurtz. "And vice versa: When patients return to us at the community hospital, the tertiary center that sends them has no easy way of knowing what's happening to them."
The two investigators decided to work together to follow up on patients, sharing resources and information important to both sites. With the assistance of an internal grant from Emory's School of Nursing, they developed a telephone follow-up system to determine patient outcomes 30 days after catheterization at Henry. Their project included patients treated medically and those referred to Emory for revascularization.
"We wanted to look at the types of problems patients transitioning between tertiary centers and community hospitals were running into and the types of services they might need," says Deaton. "Then we could start evaluating what we could do to help people with their recovery."
The bottom line in improving fragmented communication and fragmented care, say Deaton and Kurtz, is improved outcomes and decreased resource utilization. Deaton and Kurtz say in their report that it's difficult to quantify costs and potential cost savings. "Anytime we can help patients take better care of themselves, prevent problems, and recover faster, we're making it possible to avoid ED visits and decrease hospitalizations. That's our economic goal." When problems are unrecognized they go unattended, and patients are hospitalized for preventable conditions. The key is continual and consistent education beginning in the community hospital at the time of catheterization, continuing in the tertiary hospital at the time of revascularization, then continuing in the community.
Follow-up reveals patient difficulties
As nurses at Henry talk to patients in transition, they often intervene when they see a need to get services. "The contact and follow-up lets patients know that their problems are important after a procedure," Kurtz says. "They may not know whom to call. We tell them what to do for a specific problem, or we tell them not to hesitate to call their doctors." They relate an incident involving an elderly woman who'd had a revascularization but wasn't eating because she was unable to prepare meals for herself. enlisted a social worker and the woman's church to provide support and meals. We would not have known about the woman's difficulty if our study were not being done," the investigators say.
The key to continuity of care is giving patients the same message and reinforcing it, says Kurtz. "Everyone, including the patient, should be clear about what's happening. And everyone should know whom to call and what to expect. Patients should know what symptoms are indicative of problems."
The two nurses found that they worked well together and were able to pool the resources of their respective facilities. Emory Healthcare is a tertiary center with two major hospitals, 450-bed Crawford Long and 600-bed Emory. Cardiovascular staff at Emory perform approximately 2,000 bypass surgeries and 2,000 angioplasties a year. Patients come to Emory from all over the Southeast, including Henry Medical Center, a 124-bed community hospital in Stockbridge, GA. Henry does cardiac catheterizations with a mobile cath lab in its facility two days a week.
'I can't sleep and I'm tired all the time'
"We feel we've opened up an area from which we can move forward," says Deaton. "We've learned that we can pool our resources to attain mutually important information for patient follow-up."
Their study identified problems that most cardiovascular patients have in common - disrupted sleep, fatigue, worry about their illness, anxiety, shortness of breath, and chest pain. All three groups of followed patients - those medically treated, those having undergone angioplasties, and those having bypasses - had approximately the same rates of rehospitalization, between nine and 15%, during the 30 days following their procedures.
Cost Management in Cardiac Care asked Deaton and Kurtz about the nursing implications of their study. "This is the exciting part," says Kurtz. "We'd like next to explore the feasibility of having a case manager who would act as a point person for both the community and tertiary centers. Such a person would work for both institutions, follow patients, and be responsible for their care. Surely that would help communication and improve patient care." The two investigators are discussing the possibility of writing a grant proposal and formulating a new study that they hope will demonstrate the concept's cost-effectiveness.
"The problem of transitional care is not insurmountable," Deaton says. "As long as you have good people to work with in each setting, you can find a way to communicate and work together to find solutions." Deaton and Kurtz hope to present the results of their study soon.
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