Each year more than 136 million patients visit the emergency department. Many of those patients fall into the so-called "black hole" of patient care: that stage after the visit to the ED but before they can be seen again by their primary-care physician.
It's a time that can be frustrating for patients who may have questions or concerns and are unsure of where to go for answers — back to the ED, to their primary-care physician, or to their pharmacist if the question is about medications? We need to do better. As healthcare clinicians we are missing a tremendous opportunity, one that could enable us to:
• Provide better care
• Improve patient engagement and satisfaction
• Reduce return visits to the ED or admission to the hospital
It's not just patients affected by the current standard operating procedures at many EDs. Primary-care physicians often experience frustration about the lack of information provided back to them after their patient's visit to the ED. Even in this era of EHRs, not every physician can access information about care their patient received in an ED. As a result, primary-care physicians often have gaps in important patient health information.
The good news is that we're beginning to see a change. Certified PAs are often at the forefront of the effort to improve communication, collaboration, and patient hand-off back to the community physician. Here are some important ways that PAs can facilitate good patient care after treatment at the ED:
Communication. The core of value-based care and healthcare integration is communication. After treating the patient, our group will make a phone call to the primary-care physician on the patient's behalf to ensure they will have proper follow up. In instances where a patient does not have a primary-care physician, a referral will be given. One of our community clinics even provides a hotline for providers to call and make a follow-up appointment on the patient's behalf. As an emergency medicine PA, I often utilize my time during a team discharge to outline the next step in the patient's care, including contact information for follow up. In addition, our group utilizes PAs and NPs to offer "before and after" clinic hours on behalf of some community physicians in the area to further ensure the patient receives continuation of care.
Collaboration. Our group embraces value-based care by practicing across an acute care continuum. This is done through full integration of a patient's healthcare by collaborating with all specialties and ancillary staff from the moment a patient enters an urgent care center or emergency room through the time the patient is discharged home or to a skilled nursing facility. I carry out these goals by providing patient-centered care and ensuring the patient is discharged with a clear plan for follow up.
Patient hand off. It is critical for emergency medicine PAs to develop respectful and trustworthy relationships with community physicians. Fostering these relationships through frequent communication is important to exceptional, integrated, value-based care for the patient that facilitates a smooth transition from hospital to home. I would encourage community doctors to reach out to their affiliated emergency departments and find a time to personally meet the group. Most departments have monthly administrative meetings, which provide a great opportunity to meet those who care for your patients if they need emergency care, and a chance for you to share your preferences for continued care once patients are discharged from the hospital.
As an emergency medicine PA, I strive to be an extension of my attending physician, working in collaboration to provide safe, quality care to every patient using communication and integration strategies from the moment a patient enters the ER through the time they reach their final healthcare destination.
Kristy Matschullat, PA-C, is regional lead PA with CEP America, the nation's leading provider of clinical staffing solutions for hospitals and other acute care providers. She practices at Advocate Sherman Emergency Department in Elgin, Ill.
This blog was provided in partnership with the National Commission on Certification of Physician Assistants.