Let The Patient From Hell: To Observe The Nursing

4 Aug

For years hospitals have been challenged by patients who are not quite well enough to go home yet not quite sick enough to be admitted, at least right away. This limbo period, known as observation status, can be a confusing time for patients and even staff. Not anymore. SCL Health is revamping the way it handles observation care in a major initiative that’s designed to improve the patient experience and deliver more efficient care.

When a patient arrives in the ED (bleeding or out of breath or in great pain – or worse), the physician and care team must quickly see what’s going on and decide if the patient needs further care. That’s not always black or white. Sometimes it takes more time, testing and, yes, observation, to understand what’s going on.

What’s new about observation care?

These three physicians at Saint Joseph Hospital are among the many physicians systemwide who will be caring for Observation patients throughout SCL Health. Pictured are Hunaif Dar, MD; Shai Feingold, DO; and Amy Staggs, MD.

These three physicians at Saint Joseph Hospital are among the many physicians systemwide who will be caring for observation patients throughout SCL Health. Pictured are Hunaif Dar, MD; Shai Feingold, DO; and Amy Staggs, MD.

All SCL Health care sites are banding together to design and roll out a new model for observation care – from determining the patient status, coordinating care among providers and staff, streamlining documentation and order sets, and most importantly – communicating with patients.

“We asked ourselves, ‘Could this be done in a way that serves the patient better?’” said Christy Chaudhuri, MD, the co-physician lead for the project at SCL Health. “The answer was ‘Yes,’ and we are incredibly excited about our innovative new design for this specialty area of observation, and how it will improve the patient’s experience and streamline the care we provide.”

For the past nine months, teams of caregivers and leaders at every SCL Health care site have been involved in creating a comprehensive and innovative design for a new model of observation care. The design step is complete, and the organization is now beginning the full-steam-ahead process of implementing the new model by December 2015.

Watch this seven-minute video with an overview of SCL Health’s vision for the Observation Redesign project:

ObsRedesignVideoStill

What Observation Redesign means to associates
Detailed training and communication is starting to take place for the associates and caregivers who touch any aspect of observation care, including patient access, registration, nurses, physicians and patient billing. Teams are creating awareness, training and communication around these enhancements:

  • New observation care teams (OBS Navigator, OBS MD and OBS RN).
  • Orange wristbands and orange header banner in Epic for observation patients.
  • Dedicated spaces for observation patients at some of our care sites.
  • Reduced cycle times for ancillary testing for observation patients.
  • New observation Order Sets.
  • Streamlined documentation for caregivers.
  • Improved communication tools and visual aids to more quickly designate patient status and begin a care plan.
  • Patient education materials (letter, flyer, conversations).

A case study: Fred arrives in the ED, short of breath
To understand what the new model of care will look like, let’s consider the experience of a typical patient.

“Fred” arrives at the ED, acutely short of breath, with his worried wife at his side. He’s quickly registered, and the medical team begins to evaluate him. He receives an X-Ray, and the results look good. He receives a CT scan, which reveals the problem: a pulmonary embolism (one or more arteries in the lungs are blocked by a blood clot). Fred is given pain medicine, oxygen and a blood thinner, and immediately begins to breathe better.

The ED doctor discusses Fred’s care with the Hospitalist (the designated Observation MD), who makes the decision that Fred will be an Outpatient with Observation Services. He’s stable but he needs to continue to be monitored, and he’s probably not sick enough to be admitted. Observation care will keep him safe while the staff creates a care plan and monitors his condition, so he can go home as quickly as possible. Fred gets an orange wristband so the entire care team knows he is under this specialty area of expedited care.

The Observation Navigator sits down with Fred and his wife, gives them printed information and tells them what observation care means, how long Fred will likely be in the hospital, how observation costs and inpatient costs are different, and that he may have a higher co-pay and deductible. However, the Navigator helps find the best options for Fred to receive follow-up tests and care from his physician once he leaves the hospital.

By the next morning, Fred is completely stabilized and safely sent home, with a 5-day supply of self-injections and pills, and an order for follow-up care from his own physician. Fred and his wife are happy that he can be home and get the remaining care from his physician, rather than having to be in the hospital. The outpatient costs are higher than the same tests as an inpatient, but overall, Fred’s costs were less since he was in the hospital for a shorter amount of time, and his physician can provide his care moving forward.

Christy Chaudhuri, MD, FHM, CEO/Medical Director and Hospitalist of Midtown Inpatient Medicine, and co-physician lead for SCL Health’s Observation Redesign project.

Christy Chaudhuri, MD, FHM, CEO/Medical Director and Hospitalist of Midtown Inpatient Medicine, and co-physician lead for SCL Health’s Observation Redesign project.

“In the past, patients were assigned to observation status without really knowing what that meant, what it would cost, whether they needed to be admitted to the hospital in the first place or if they could get the necessary care from their own physician,” said Dr. Chaudhuri. “Now they will understand what observation means and their stay will feel more like expedited care in an outpatient setting.”

It’s a new era of healthcare, and all health systems are trying to understand how to provide excellent care more efficiently. SCL Health is embracing this new care model designed to meet the needs of patients and caregivers by streamlining the process for all involved.


Questions about the Observation Redesign process? Please contact one of the following care site team leaders:

  • St. Vincent Healthcare – BJ Gilmore, CNO, or Katie Roedocker
  • St. James Healthcare – Shannon Holland, CNO, or Helen Cummings
  • Holy Rosary Healthcare – Carol Enderle, VP Patient Care, or Alisha Anderson
  • St. Francis Health – Mary Clare Wilson, Director Quality
  • Lutheran Medical Center – Christina Johnson, CMO, or John Valentino
  • St. Mary’s Medical Center – Shelley Peterson, CNO, or Ann Jeffries
  • Saint Joseph Hospital – Barb Jahn, COO, or Deborah Campbell
  • Good Samaritan Medical Center – Susan Kerschen, CNO, or Barbara Carnes/George Payan

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