BIDMC

1
Bridging the Gap Between Routine Primary Care and
Urgent CareScot B. Sternberg, MS, Candace
Reynolds, RN, Katherine Chiulli, RN, Kim
Ariyabuddhiphongs, MD, Louise Mackisack, MA,
Vasudev Mandyam, MD Beth Israel Deaconess
Medical Center, Harvard Medical School, Boston, MA

• BIDMCs HealthCare Associates (HCA) is an
  academic adult primary care practice over
  41,000 patients and 100,000 visits per year.
• A large number of episodic" patient visits, for
  acute complaints including shortness of breath,
  dehydration, and cellulitis.
• There had been no infrastructure to provide acute
  treatments in the clinic and potentially bypass
  an Emergency Department visit.
• Develop an Acute Treatment Service (ATS) within
  HCA to provide the right care at the right time.
• Treat low-acuity patients who may otherwise need
  to be sent to the ED.
• Continue to expand services and treatments
  offered, to progress towards capturing a wider
  array of conditions and acuity.
• Identified three treatments to provide IV
  fluids, IV antibiotics, and nebulizers.
• Implementation included retro-fitting of existing
  space providing enhanced training for nursing
  staff setup of on-site medications standardized
  treatment and discharge plans.
• Nursing staff provides treatments, overseen by a
  physician provider.
• Developed a database to measure and track ATS
  interventions, disposition, and time spent.
  Patients discharged home are also tracked for 7
  days following the visit for any subsequent ED
  visit and/or hospitalization.

Findings to date
Problem

• The Results/Progress to Date
• Patients who have accessed ATS have received it
  very favorably.
• Data shows HCA can offer these acute services
  integrated into the primary care setting using
  existing resources and can avoid unnecessary ED
  visits.

Objective
Key Lessons Learned
Description of the Intervention, including
context
Next Steps
¹Special recognition and acknowledgement to the
HCA nurses who staff the ATS, including Anne
Bassler, RN Arvetta Boykins, RN Kathy Chiulli,
RN Melissa Cote, RN Sue Dinneen, RN Michelle
Fiorenzo, RN Janet Greene, RN Cathy Ivkovic,
RN Barbara Luker, RN Maureen Mamet, RN Deb
Schissler, RN Tarsha Soares, RN Kristine
Sullivan, RN Francine Theberge, RN Jan
Woodruff, RN
For More Information, Contact Vasudev Mandyam,,
MD/ vmandyam_at_bidmc.harvard.edu