The Department of Emergency Medicine with Vanderbilt Health has established a Program in Unplanned Care to enhance the quality, efficiency and cost-effectiveness of urgent and emergency care provided prior to hospital admission.
The initiative is supported by a $1.3 million endowment from the department, with additional funding from the Vanderbilt Center for Health Services Research.
“Unplanned care refers to medical care arising from unexpected health issues that require immediate or urgent attention,” said Jin Han, MD, MSc, professor of Emergency Medicine and program co-director with Michael Ward, MD, PhD, MBA, the department’s vice chair for Research.
“Systemic inefficiencies” in providing unplanned care to patients who have developed unexpected, acute illnesses, for example, can delay treatment and increase costs. Must patients come to the hospital emergency department for urgent testing, or can a walk-in clinic provide the testing more efficiently?
The program’s goal is to foster an environment that examines and systematically addresses these inefficiencies. Older adults are of particular interest because “they are medically complex and tend to be vulnerable to the inefficiencies of the health care system,” the researchers said.
“Unplanned care can occur in walk-in clinics, telehealth visits and emergency departments, and some will require hospital admission to address their unexpected health challenges,” Han explained. “Aligning the right care, at the right time, in a patient-centric way is uniquely challenging for unplanned care.”
Initially the program will focus on three strategic initiatives: fostering and developing a community of academicians, operational partners, research groups and trainees interested in unplanned care research and quality improvement; supporting investigators in their studies of unplanned care; and identifying and addressing challenges in unplanned care research and quality improvement.
For example, a paramedic program could be developed that would send paramedics to the homes of older people to determine whether they need to be seen in the ED and possibly admitted, Han and Ward said.
If admitted, what is the best way to provide care as early as possible to minimize complications such as falls, pressure ulcers or delirium? After discharge, can follow-up home visits by the paramedics reduce the risk of hospital readmission?
The program will use an interdisciplinary approach that combines operations research, systems science, implementation science, qualitative research and biomedical informatics, in collaboration with the program’s operational partners to systematically identify and address challenges in unplanned care.
“We are excited to partner with the Department of Emergency Medicine in supporting this important new program, which will study ways to enhance quality, value and equity of health care delivery and outcomes,” said Sunil Kripalani, MD, MSc, director of the Center for Health Services Research and VUMC Vice President for Health System Sciences.
Han and Ward said that, to their knowledge, the program is unique in that it focuses on the patient, starting from the prehospital setting, through the ED, and to the inpatient ward or intensive care unit.
“Systems of care must be put in place to ensure that care is delivered equitably and that every patient with an unexpected illness is treated with dignity and respect,” said Ward, professor of Emergency Medicine and Biomedical Informatics.
“Treating each person with dignity, regardless of where they enter the health system, is central to our department’s mission and ethos,” added Erik Hess, MD, MSc, professor and chair of Emergency Medicine. “Rigorous, collaborative research to improve access to care, and building a coalition to test real-world solutions are critical to carrying out our mission.”
For more information, visit www.vanderbiltem.com/puc or contact Katy Branson at 615-936-0253.