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One of the great challenges in the whole world of quality and patient safety is learning to take advantage of the richness of clinical cases, says Robert M. Wachter, MD, professor and associate chairman in the department of medicine at the University of California, San Francisco (UCSF) and chief of the medical service at UCSF Medical Center.
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A team approach and intensive case management of patients has helped San Francisco General Hospital cut the number of hospitalizations and costs for patients who were frequently hospitalized.
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Hospital discharge planners often have to use their ingenuity in finding placements for patients with no insurance who need post-acute services or are homeless and need a place to stay. The problem is that patients must be discharged safely, whether or not they have money to pay for the services they need.
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A pediatric asthma program that includes home visits by an asthma management team and an intensive educational program for families has resulted in a dramatic drop in emergency department (ED) visits for pediatric asthma patients at Hurley Medical Center in Flint, MI.
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The movement to prevent wrong-site or wrong-person surgery got another boost recently when a major health plan announced affective Jan. 1, 2005, it will no longer pay for medical procedures involving those egregious errors. Dont expect to get paid for a procedure if you leave that 12-inch retractor in the patients belly, or the next procedure to remove it.
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Case managers with the Hawaii Medical Service Association (HMSA), a nonprofit medical indemnity association, follow a practice model that differs significantly from that used at most other insurance companies, says Melissa Bojorquez, ACBSW, MBA, CCM, supervisor for the HMSA case management program.
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For the emergency physician, sexual assault represents the most common presenting complaint associated with the potential for an unintended pregnancy. Annually, approximately 40,000 people in the United States visit EDs after sexual assault. Pregnancy is estimated to occur in approximately 5% of sexual assaults. Thus, pregnancy prevention is an important part of the care for these patients. For the emergency physician, EC represents the most viable treatment option. However, while highly effective when used properly, it is associated with a number of issues that make it much less commonly used.
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