MedStar Health Emergency Department Internal Innovation Challenge

Impact

The judges selected two winners:

It’s 2019, and we read a medical record number (MRN) on the phone to admit a patient? A hospitalist communication system for admissions
Carolyn Phillips and Michael Yacovelli; MedStar Washington Hospital Center and MedStar Georgetown University Hospital; Emergency medicine resident and attending physician team

When ED providers seek to admit their patients into the hospital, they communicate with the hospitalist team: a group of internal medicine providers who care for patients solely while they are in the hospital. Despite electronic health record (EHR) and text messaging technology, however, the current process requires ED providers to page the admitting hospitalist without any information about why they are paging. Basic patient information (e.g., patient name, MRN, medical history, presenting chief complaint, and pertinent lab) that is already available in the EHR must be communicated over the phone. This idea envisions leveraging technology that facilitates communication between hospitalists and the ED providers—so the hospitalists can better review cases before responding to ED providers. The team is exploring the short- and long-term technology and workflow solutions, including use of pre-existing EHR orders for hospitalist consults, automatic messages to hospitalists to flag these consults, and an integrated mobile secure messaging app.

Less PercoceT and more PT: The MedStar Health Urgent Physical Therapy Program
Munish Goyal, John Brickley, Lindsay Batson, and Liz Delasobera; MedStar National Rehabilitation Hospital, MedStar Washington Hospital Center, MedStar Georgetown University Hospital, and MedStar Health Urgent Care; Physician and physical therapist team

Patients commonly turn to EDs and Urgent Care sites for management of their soft tissue injuries (e.g., ankle sprains). They are often prescribed pain medications and advised to follow up with their primary care doctor, orthopedist, or podiatrist for an appointment at a later date. Alternatively, this winning idea proposes that emergency providers prescribe early physical therapy, which optimally includes an appointment within a day, to strive for benefits such as reduced inflammation, targeted strengthening, neuromuscular re-education, reduced pain, less medication (including opiate) use, and faster and safer return to function. However, it’s difficult for many emergency providers to make a warm handoff to a physical therapist due to access issues and uncertainty with insurance requirements. The team proposes building a seamless, comprehensive system to ensure quick patient access to physical therapy. The solution includes providers placing an order for physical therapy in the EHR and the ability to send one email to MedStar Health central scheduling to manage the one-day referral and insurance needs. The team also envisions working with MI2’s MedStar Telehealth Innovation Center to ensure a telehealth physiatry visit, with the physical therapist mediating that telehealth appointment between the patient and physiatrist.