Healthcare As Patient Care

FEATURES January 2011

Healthcare As Patient Care

As a greater number of patients gain access to health insurance, quality of care becomes more important than ever. In Hampton Roads, patients measure quality by a set of standards medical providers are just beginning to appreciate.

By: Deborah Huso

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When former Miss Virginia International and Portsmouth resident Tamika Mills was a victim in a near fatal car accident two years ago, she had her first experience as a patient in a hospital, as many of us do, through the emergency room. Taken to Sentara Norfolk General Hospital, the region's only Level I Trauma Center, Mills learned her left ankle was broken in three places, that her bottom teeth had been knocked back by the steering wheel of her car, and that one of her top teeth had been broken in half and the enamel shattered on another.

"When I was in the ambulance, nothing hurt, though both of my jaws were broken," Mills recalls. "I heard one of the EMTs mention that one of my teeth was broken, and I immediately started crying." A dental hygienist, volunteer for Operation Smile, and active pageant participant, Mills considered her smile her best asset. "I was so worried about what my mouth was going to look like."

Mills stayed at Sentara Norfolk General for a week before being referred to a facial surgeon. "They were very nice and took really good care of me," she remembers. "When I was in pain and pushed the button, they came immediately."

While hospital and clinic administrators, physicians, and nurses may often gauge quality of care based on the number of services they provide, the specialties they offer, the certifications they meet, and the number of cases successfully treated, patients tend to measure the quality of health care in a very different way. Tamika Mills is a prime example. Her main standards for determining a good patient experience were feeling cared for and receiving prompt attention when she needed it.

It's a reality the medical community is slowly but surely coming to recognize, and it's changing the way many patients are being received here in Hampton Roads.

The Patient as Customer
"In the last 20 years, we've seen a transformation of patients into customers," says Carl Wentzel, M.D., emergency department medical director of Bon Secours Health Center at Harbour View in Suffolk. "There's a person behind that chest pain. We're seeing it as a customer service industry as well as a health care industry."

The change is a needed one. Patricia Armstrong, a retired psychologist turned private investigator who resides in Hampton, says she spent many years receiving care at Riverside Family Medicine in Newport News but eventually became frustrated with the fact that while she could get walkin service, she was never able to see the same physician twice. "I finally moved to Riverside Internal Medicine and now see one physician regularly rather than half a dozen different people who graduate every three years," she says.

For Armstrong and countless patients like her, quality of care means knowing your care providers and having them know you.

"Physicians are monitored and critiqued on customer service skills as much as clinical skills these days," Wentzel points out. That emphasis on customer service is one reason hospitals and clinics around the region are transforming the way they deliver services, particularly in their emergency departments, which is where most patients will have their first hospital experience.

"Hospitals have come to realize that the emergency department is the 'front door' to the hospital," Wentzel explains. "A significant portion of admitted patients come through emergency departments, and a big percentage of hospital revenue originates in emergency departments."

That's why Bon Secours has instituted No Wait Emergency Care at its hospitals. The first person patients see is a health care provider, not an administrative person. "All the initial barriers have been removed," Wentzel says, pointing out that patients are directed immediately to a triage nurse who performs a one to two minute assessment, and then the patient is directed into a room where he'll receive care from a nurse or doctor while the registration staff can sit at the bedside with a laptop to obtain personal medical information while the patient is simultaneously receiving care. "What used to be a linear process has turned parallel," Wentzel explains. And that change has been largely patient driven. Patients will go to the hospital where they receive the most prompt care.

Dr. Gene Burke, M.D., vice president of quality and clinical effectiveness for Sentara Healthcare, says Sentara's emergency rooms have moved to the same model and have even taken it one step further by trying to direct patients who are not in a trauma situation to try out Sentara's 10 urgent care facilities around the region.

Health Care for Everyone
Dr. David Maizel, executive medical director of Sentara Medical Group, says emergency rooms have always carried a large burden of primary care because that's where patients go who don't have insurance. With the recent economic downturn and many families suffering job losses and consequent loss of health insurance, emergency rooms have seen even more traffic. But Maizel says if patients can seek care for minor emergencies, like a sprained ankle or flu symptoms, at urgent care centers, they'll have much lower costs. Maizel says Sentara's urgent care centers, for example, offer sliding scale payments based on a patient's income level.

On the other hand, emergency rooms are increasingly designed to accommodate primary care. Wentzel at Bon Secours says at least half of the patients he sees coming into Harbour View are seeking primary care services and are not suffering from accident trauma, chest pain, or broken bones—the types of injuries and illnesses we typically associate with emergency medicine. "From a physician's point of view, that used to be problematic," Wentzel says, "but now it's so common for patients to seek primary care in emergency rooms that many young doctors go into emergency medicine precisely to care for people who have nowhere else to go."

Sometimes those patients lack health insurance, but often they just can't get appointments with their own primary care physicians. Wentzel is quick to admit that primary care in Hampton Roads "is not as robust as it should be." There just aren't enough general practitioners for all the people who need them. Wentzel expects that problem to grow as more Americans gain access to affordable health insurance in the coming months and years. "Emergency care visits may go through the roof when universal health insurance becomes available," he says. Besides the fact that there just aren't enough physicians to service everyone, plenty of doctors won't accept Medicaid.

Sentara is already working to address this growing problem by overhauling its primary care practices. It has begun a pilot program to increase efficiency in the delivery of primary care by making greater use of nurse practitioners and physician's assistants, who often have the skills and certifications to perform a lot of the same tasks doctors do. "In our pilot program, we've actually created the equivalent of an extra doctor by opening 30 spots a day at a seven-doctor clinic," says Burke. Maizel says the implementation of electronic health records system-wide at Sentara is also improving patient care and increasing efficiency. It makes collaboration among doctors easier and enables a physician to see at a glance what medicines a patient is taking, what other health issues she has and what diagnoses she has received.


For the rest of this article, see the January 2011 issue of Hampton Roads Magazine

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