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Group 3

Clinioal Care 3oenario


loenr|f,|ng rhe oause of
o,spnea ano eoema |n a 71 ,r o|o woman
MMI 402 (David Liebovitz, MD)
Northwestern University, FaII 2009
AIicia Barco, Connie Egerer, DougIas Kunz, Kerry
Heinecke
ovember 30, 2009
enda
#eaI Life CIinicaI Case Scenario
The EM#'auIt v2010 Scenario
Key features of EM#'auIt v2010
How EM#'auIt v2010 improved our Patient's
case
#eal Life Case History (names
chaned)
Lab #esults
B! = 71 (rules out heart failure)
Hemolobin = 9.8
Creatinine = 1.6
Liver tests were borderline hih
!rotein/albumin were low (possibly indicatin malnutrition)
!otassium results not back yet
Ferritin = normal
Chest xray showed fluid in the luns (the physician thouht
it could be low protein in blood which makes water seep
into tissue. He notes that #heumatoid rthritis can cause
low protein.)
O2 sats = 98%
TSH 4.17 (normal thyroid test)
rs. Smith is Sent Home
edicare would not pay for further hospitalization
Shortness of breath and swellin persisted
Continue lasix
See family physician
Follow up appointment with nephroloist
rs. Smith is sent back to the E#
Follow up visit with nephroloist
ephroloist listens to her luns
rs. Smith sent immediately to the E#
Oxyen administered
Thoracentesis on both luns
ore normal test results
Kidney
Heart
Liver
ianosis
eck to hip CT Scan
dentified swollen lymph nodes
Chest
bdomen
!elvic area (lymph nodes compressin bladder)
!reliminary dianosis Lymphoma
Biopsy confirms follicular non-Hodkins lymphoma
Chemotherapy successful
ata sent throuh #HO exchane
rs. Smith is ischared
Follow-up actions performed as dischare preparation:
1. ssessment of post-dischare care available at home
(family careivers).
2. Education iven to patient and family on medications
manaement
3. ppointment booked with family physician
4. ischare summary transmitted from hospital's inpatient
E# to family physician.
5. Schedule follow up calls and arrane patient monitorin
6. !repared patient dischare instructions and information to
ive to patient and family.
ischare !lan
DiscIaimer: The picture
beIow is a Spirometer
ActuaI Dyspnea monitor
not deveIoped yet.
!atient dischare instructions/information:
1. edication list to printout for patient with instructions
2. "#ed flas when to call provider (e.., increased difficulty
breathin); dyspnea monitor device was iven to patient (sends
alert messae to doctor)
3. Family appointment reminder printout
4. #eview of schedule for follow up calls and patient monitorin
Follow-up catches worsenin condition
Worsenin dyspnea and edema and development of orthopnea
and abdominal swellin are quickly noted by the nurse practitioner
rs. Smith's appointment with her family physician is moved up
The family physician, equipped with full history, reconizes the
need to re-admit her to the hospital
nd the happy resolution is achieved more quickly and smoothly
Key Features of E#'ault v2010
!hysician Task and Workflow Orientation
L! capable
Clinical notes, C!T codin
!roblem list (SOE CT, C 9/10)
edication anaement (allery list)
mae anaement
Lab anaement
Clinical ecision Support
Health aintenance anaement (alerts/reminders, vital sins)
C!OE
Calendars, Task lists
Key Features of E#'ault v2010
(continued.)
Communication with external Systems
External E#s via #HO
!harmacy
Lab
'oice activated data collection devices
#emote patient monitorin devices
Critical workflow handlin by the system (alerts/notifications sent
throuh SS pain and instantaneously displayed in E#
system)
! interation to other systems such as
ifferential ianosis (x!lain)
Clinical ecision Support
Clinical !rediction #ules (edCalc3000)
!CS
How E#'ault v2010 improved rs.
Smith's care
Smooth communication between providers
Between the different physician offices
Within the hospital
Eliminatin redundant testin
#educed delays in dianosis
Clinical ecision Support
E# recommended tests
Supported Follow up care after release from the hospital
Faster reconition of worsenin condition
Closer patient contact made patient feel cared for
"uestions?
Group 3 members
orthwestern University, Fall2009
licia Barco, Connie Eerer, oulas Kunz, Kerry Heinecke
%,nk you for your ,ttention
%e slides will be posted in our Cl,ssroom Discussion Bo,rd
We enjoyed tis cl,ss.
%,nk you Dr. D,;id Liebo;itz

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