Hospitalists Emphasize Continuity of Care
Primary care providers not only know that the patients they refer to North Kansas City Hospital will receive top quality care, they can also trust that they will be involved during the entirety of their patients’ hospital stay.
One call to the Transfer Center starts the admission process. Staffed by RNs, the Transfer Center coordinates with the referring physician, hospitalists, the Admitting department and the Admitting Assessment Unit.
The AAU is staffed by a team of nurses dedicated solely to admitting patients. They gather information, assess patients’ medications and health history and collaborate with hospitalists to begin evaluation and treatment.
“Many patients travel from small towns such as Carrollton, Chillicothe, Cameron, Excelsior Springs, Richmond and Trenton and if a direct admission is appropriate, we get them in a bed on the floor as quickly as possible. Of course unstable patients should be evaluated in the ER,” explains Matthew Woody, MD, of Northland Hospitalists.
The hospital also has processes in place to help ensure patients are cleared for elective surgeries . Patients with chronic health concerns, such as diabetes, high blood pressure or lung disease, are required to have a presurgical appointment two weeks prior to their procedures. During their visit, a hospitalist assesses the patient to ensure he/she is physically prepared to undergo the procedure.
“This gives us a chance to evaluate patients and prepare them for surgery which improves their outcomes,” says Lancer Gates, DO, with Gates Hospitalists LLC. “For non-emergent situations, we may also consult with their primary care physician to adjust medications or order further tests to ensure the patient is ready for surgery.”
Dr. Gates says that – prior to surgery – hospitalists have identified untreated dental abscesses, patients whom had yet to complete a course of anticoagulants and stabilized patients with uncontrolled diabetes.
Communication is Key
Throughout the hospitalization process – admissions, treatment and discharge – the physicians at NKCH remain in close contact with the patient’s referring physician.
“At NKCH, we feel the primary care physician is the leader of the care team whether or not they are physically present at the hospital,” Dr. Gates says. “And our hospitalists serve the primary care doctors through a variety of communications.”
PCP Census is an online communication tool that allows referring physicians to review patient records and care plans 24/7. The PCP Census lists patients who are currently hospitalized, recently discharged or have visited the NKCH emergency room in the previous two weeks. This allows primary care physicians to contact patients for post-discharge follow-up appointments that helps avoid readmissions. To request access to the PCP Census portal, contact Kristen Sweeney, physician liaison, at 816.691.5023.
Discharge summaries are dictated and transcribed at the time of discharge to ensure availability prior to a patient’s follow-up visit. Additionally, it is standard practice at NKCH that all physicians recommend to their patients that they see their primary care physician within one week of their discharge.
Social Services also help with the discharge and post-discharge process. A care coordinator contacts the primary care doctor, facilitates follow-up appointments, ensures the patient has access to medications and necessary transportation, and coordinates home health services.
Matthew Woody, MD
Dr. Woody earned his MD and completed his internal medicine residency at The University of Missouri – Kansas City School of Medicine. He was an assistant professor of medicine at the university from 2002 to 2004. Before he started Northland Hospitalists in 2005 with two partners, Dr. Woody worked in a group internal medicine practice and was director of the anticoagulation clinic at Truman Medical Center. He has served as a board member of two local nonprofits, the Liberty School District Foundation and Earth Riders Trails Association.
Lancer Gates, DO
After he earned his DO from Kirksville College of Osteopathic Medicine, Dr. Gates completed his internal medicine residency at Wilson Memorial Hospital, Binghamton, N.Y. In 2002 he founded Gates Hospitalists LLC. Dr. Gates is a councilor of the Missouri State Medical Society, and serves on the editorial board of Missouri Medicine: the Journal of the Missouri State Medical Association. He is the 2014 president of the Metropolitan Medical Society of Greater Kansas City, and has received the physician of the year award for 2008 from the Missouri Association of Osteopathic Physicians and Surgeons.
To learn more, call:
- Gates Hospitalists, LLC 816-968-9320
- Northland Hospitalists, LLC 816-455-0681
- Transfer Center 816-691-1584