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Wednesday, January 19, 2011

Without a single E.R. visit: The Special Care Center

Dr. Atul Gawande's description of the morning huddles by an innovative medical practice:
The Special Care Center in Atlantic City, New Jersey houses an experiment started in 2007 by the health-benefit programs of the casino worker's union and AtlantiCare Medical Center, the city's two largest employers.

Dr. Rushika Fernandopulle runs the clinic just for workers with very high medical costs. A staff meeting each morning reviews the medical issues of the patients on that day’s appointment books. Clinicians popped open their laptops and pulled up their patient lists together. A full-time social worker and the receptionist joined the doctors and nurses. Outnumbering them all were eight full-time "health coaches" from the patients' communities.

In 45 minutes the staff ran through everyone's patients. They reviewed the requests that patients had made by email or phone, and the plans for the ones with appointments that day. Staff made sure that all patients who made a sick visit the day before got a follow-up call within 24 hours, that every test was reviewed, and that every unexpected problem was addressed.

Most patients required no more than 10 seconds. Mr. Green didn't turn up for his cardiac testing or return calls about it. "I know where his wife works. I'll track her down," the receptionist said. Ms. Blue is pregnant and on a medication for high blood pressure that's unsafe for pregnant women. "I'll change her prescription right now," said her doctor, and did so.

Other patients required longer discussions. A middle-aged heart-disease patient's recent blood tests showed worsening kidney failure. The team decided to repeat the blood tests that morning, organize a kidney ultrasound in the afternoon if the tests confirmed the finding, and have him seen in the office at the end of the day.

A staff member read out the hospital census. Of the clinic's 1200 chronically ill patients, just one was in the hospital, and she was being discharged. The clinic's patients had gone four days without a single E.R. visit. On hearing this, staff cheered and broke into applause.

Read another story by Dr. Atul Gawande.

Thanks to Dr. Atul Gawande for the source article in the Jan. 24 issue of The New Yorker.

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