Grady Memorial Hospital was founded in 1892, has become a leading hospital in the United States as a safety-net hospital, as well as a recognized level one trauma center. It is no secret that a majority of the patients that enter into the hospital are those of Medicaid and Medicare, and high deductible plan patients. When the nation was faced with the recession in 2009, Grady experienced an influx of Atlanteans visiting their emergency room department. The influx was due to people losing their jobs from layoffs, therefore resulting in the loss of insurance coverage (Williams, 2011). Not all the patients that entered the department at the time were urgent cases, leading to extensive waiting times, up to ten hours, since every patient had to be thoroughly checked for life threatening symptoms. Non-urgent visits to the Atlanta based hospital was costing the facility millions of dollars each year, placing them in debt. In the past years, Grady has realized that change was necessary in keeping their historic doors open. The health care provider has reconstructed themselves in to being more efficient for homeless and low-income patients in Fulton and Dekalb counties. John Haupert, CEO, was welcomed to GMS in 2009 has successfully transformed the manner in which health care is delivered to patients, including more staff, and most importantly coordinated care for the emergency department. To better understand the improvements, it would be necessary to answer the question as to how Grady Memorial Hospital has improved in efficiency and quality of care in this department?
The first way in which the health care center has improved efficiency in 2018 was by leasing Carolina HealthCare System’s MED-1 unit. MED-1 comes equipped with fourteen beds, as well as fully functioning life saving devices that would be located in a regular emergency bedroom. This unit assists the hospital in controlling overcrowding while reducing wait times in the recent increase from four hundred on a typical day to five hundred. Atlanta physicians have contributed the increase to the heightened flu season and other viral diseases (Miller, 2018).
The second way that GMS is improving efficiency and quality in emergency services is through coordinated care. Coordinated care is when two or more healthcare participants are involved in the care of a patient to ensure quality service(s) (Group Health Research Institute, 2011). Research found that visits to the Grady ER increased by ten percent in 2017, from 129,000 annual visits to 141,693. To reduce the volume of readmissions, the institution has decided to implement four different manners to provide quality care for frequent emergency patients. Patients are categorized as frequent when they have visited the ER more than twelve times a year, even though recently it has been reduced to those who come six times a year. The first step was in establishing the Chronic Care Clinic (CCC). The goal of the CCC is to provide patients with the right care at the right time by connecting them with primary care physicians. Each plan is individualized, therefore diversifying Grady from other health care systems as they take the necessary steps to learn and understand the patient’s lifestyle before giving them treatments based on previous patients. The Chronic Care department also provides financial, housing and transportation to those at the facility (Grady Health System, 2017, pp. 2,7).
Mobile Integrated Health section of the department is the second step to providing efficiency. This section is for those with chronic care frequenters of the emergency department. Grady’s medical staff evaluates the patient when they check in to decide if they are in need of supportive care at home, in which a nurse practitioner and paramedic are sent to the homes of the ill to perform in house treatments (Grady Health System, 2017, pp. 2,9). A paramedic can be partnered with either a mental health social worker or a physician in a trip. This procedure is also known as community paramedicine. Community paramedicine is utilized in non-emergency situations so that the patient does not have to call for an ambulance. It has been reported that in the surrounding Grady area, people were calling 911 for occurrences such as prescription refills or not having the ability to comprehend the medication instructions. This segment saves the hospital money in ambulatory and hospitalization fees as they will not get penalized by the CMS for readmission for Medicare and Medicaid patients (Miller, Community Paramedicine: Unclogging ERs by helping people at home, 2016). Those who are recipients of paramedicine enjoy having a doctor come visit them and not having to get transported to Grady.
Transitions to care is the third step, as it provides those discharged with a support team for thirty to sixty days. This team was designed with responsibility to ensure that patients are following physician instructions and taking their medications (Grady Health System, 2017, p. 7).
Another manner that GMS is improving their quality is by attempting to offer lower costs to patients for health care services. Grady has discovered that 20,000 of the 100,000 of those that enter the department could have been treated by a primary care physician instead of the ER at a much lower cost. The institution has also discovered that people do not understand how to utilize the healthcare system to their advantage, as in getting annual physicals or obtaining refills on prescriptions. Emergency department staff evaluate the patients and determine if their case is life threatening. If not, they will be given the option to go to the Grady walk-in clinic for assistance. In 2011, Grady also decide to raise their co-pay to $150 from $50 to $75 as an incentive to use the walk-in clinic, which only cost $50. At the clinic, patient navigators direct those referred from the hospital to a Grady neighborhood clinics or health care provider (Williams, Grady to Open Er Alternative Offering Lower Costs, 2011). The goal of the referral process is to start habits for frequent patients to visit a primary physician consistently. This is another process that saves the hospital money, opens up the ER and reduces waiting times.
In conclusion, Grady Memorial Hospital is emerging as a leading hospital in their emergency department as Haupert and staff have dedicated time and energy to reducing overall waiting times, making patients comfortable with making appointments to a primary care physician and reducing costs for both the hospital and the patient. They have been open to outside opportunities to thrive in Atlanta through the MED-1 unit to reduce the wait times during the intense flu season as well as having physicians make house calls again. Their efforts such as these make patients more likely to make their health a priority now and, in the future, especially with initiatives such as the Chronic Care Clinic that customizing health plans. Patient navigators have been an essential piece in the health journey of frequent Grady patients in finding the right doctor to fit their needs. Coordinated care has changed the way that patients are handled in the health care system as they understand that a majority of their visitors are from low-income neighborhoods, therefore they attempt to accommodate in areas that most hospitals would choose not to do. Grady Memorial Hospital has just started their journey on reaching optimum quality care and efficiency for the Atlanta area, but CEO Haupert and staff are not demonstrating signs of slowing down.
