Optimizing capacity and the patient experience: Checking in on St. Joe’s partnerships in Ann Arbor, Chelsea

Two unique collaborations with Saint Joseph Mercy Health System (SJMHS) have paved the way for improved patient access to Michigan Medicine.

Adults requiring inpatient admission are now being presented two new alternatives to University Hospital: the 10 East Medicine Unit at St. Joseph Mercy Ann Arbor (SJMAA) and St. Joseph Mercy Chelsea (SJMC).

Now that these options are being regularly recommended to patients, Headlines asked Michigan Medicine physicians at each location — hospitalist Rafina Khateeb, M.D., M.B.A., at SJMAA, and family medicine physician William Chavey, M.D., at SJMC — for a progress report.

The right place for the right care

While patients with complex medical conditions need the advanced specialty and subspecialty care concentrated on the main hospital campus, that does not describe every patient needing hospital admission. Alternatively, for those with less specialty needs, it may make sense to consider admission to the 10 East Medicine Unit at SJMAA or SJMC, where care coordinated by Michigan Medicine physicians can be delivered with convenience and confidence.

“These options can now be discussed with most non-surgical patients who do not require admission to a Michigan Medicine specialty service,” said Chavey. “They are appropriate alternatives for patients needing evaluation or treatment for many common or chronic issues or injuries.”

Currently, about 95 percent of admission decisions are made in Michigan Medicine’s emergency department (ED). There, a triage hospitalist, in collaboration with adult emergency services (AES) providers, determines whether the patient meets the inclusion criteria for admission to the 10 East Medicine Unit or SJMC and coordinates the transfer.

The balance of admissions come directly from ambulatory clinics or ambulatory diagnostic and treatment units (ADTU) and referrals to SJMAA and SJMC emergency departments.

“Clinic and ADTU doctors now have more direct admission opportunities,” said Khateeb, “which can help some patients avoid a trip to the emergency room entirely.”

St. Joseph Mercy Ann Arbor 10 East Medicine Unit

The 2018 professional service agreement with SJMHS opened the door for Michigan Medicine physicians to provide care on the 10 East Medicine Unit at SJMAA, nicknamed “the Michigan Unit at St Joe’s,” or MSJ.

Staffed 24/7 by Michigan Medicine physicians supported by St. Joe’s nurses, technicians and staff, the 10 East Medicine Unit, formerly a jointly-operated Acute Care for Elders (ACE) unit, continues to provide specialized geriatric care, in addition to caring for adult general medicine patients requiring admission.

How’s it going so far? “It’s already exceeding expectations,” said Khateeb. “To date, more than 1,000 patients have been admitted to the unit, and many are requesting to go back if a future admission is needed.”

St. Joseph Mercy Chelsea

In the summer of 2018, Michigan Medicine and SJMHS partnered to provide care through SJMC as a joint venture, building on a collaboration in family medicine that goes back 40 years. Through the venture, surgical services have expanded to include bariatric surgery, and Michigan Medicine admissions to the newly-renovated SJMC began in February.

While the Chelsea option has only been available for a few months, Chavey anticipates a positive reception as more ED and clinic physicians discuss it with patients.

“As our Michigan Medicine admissions increase,” he said, “we’ll build on the family medicine expertise already in place to make sure we’re offering the right services and specialties for the patients we admit here.”

A hit with patients and families

“We’re so excited to be able to offer these alternatives,” said Khateeb and Chavey. “Convenience and expertise are both important to patients and families. Now they don’t have to trade one for the other.”

Feedback from patients and families is very positive.

One example came in a letter from a patient brought by ambulance to Michigan Medicine in December after losing consciousness in the shower and awaking with a broken nose and numerous cuts and bruises. When it was determined that admission was needed for further observation, the attending physician recommended transfer to the 10 East Medicine Unit. In his letter, he thanked doctors and staff at both locations for the prompt attention and excellent care he received. “The residents of this area are so fortunate to live so close to the remarkable care that is available almost at a moment’s notice,” he wrote.

Keys to success: communication, coordination

Right now, about half of patients presented with an alternative admission destination take advantage of it. That percentage is expected to increase as physicians become more comfortable recommending these options.

A number of steps have been taken to improve communication and coordination of care. In the past, the only MiChart AES referral option available in a clinic or ADTU was to Michigan Medicine. Providers are now prompted in MiChart to consider SJMAA and SJMC ED for evaluation and possible admission to MSJ and Chelsea Family Medicine (CFM), respectively.

Because SJMHS uses a different electronic medical records system, Michigan Medicine primary care or specialty physicians may not always have immediate access to updated patient information while they’re admitted. Until SJMHS migrates to Epic (anticipated in January 2020), a dedicated clinical assistant is available to help bridge the gap — notifying and updating physicians, scanning relevant records into the MiChart media tab and arranging follow-up appointments.

“Ideally, it’s best to make patients aware of their alternatives and endorse them before they actually need hospital admission,” said Khateeb. “At the moment an admission decision is being made, chances are the patient is in crisis. That’s not the best time to introduce any new concept, even a beneficial one.”

Chavey agreed: “We hope primary care physicians and specialists will start the conversation earlier, letting patients know that if an admission is required at some point, we may recommend an option besides the main hospital if we feel it is the right choice for you.”

Anyone with questions about these inpatient collaborations should contact Khateeb (about the Medicine Unit at SJMAA) or Chavey (about SJMC).