The Power of Connected Care
An Accountable Care Organization patient had a surgical procedure at a non-Bridges facility. Because of Bridges partnership with CCHIE (Clinical Connect Health Information Exchange), discharge information is received from select facilities outside of Bridges. As a result, the Bridges Care Coordinator was notified in EagleDream of this patient’s recent discharge. She promptly escalated the case to the responsible Care Manager due to the length of the patient stay.
The Bridges Care Manager outreached the same day and discovered that the patient reported chills and a temperature of 100-101 since being home and had been unable to connect with the surgeon’s office. She educated the spouse on the signs and symptoms of infection to watch for and immediately called the orthopedic surgeon’s office for guidance. The Care Manager was directed to the patient’s Primary Care Provider, whom she notified of the situation. The primary care office directed the patient to the mobile lab for blood work and a urine culture/urinalysis. She was diagnosed with an infection for which she was given antibiotics. The Care Manager ensured the patient was able to pick up her prescription and that she tolerated the new medication. The infection has since improved, and the patient is recovering from her surgery. She continues to be followed during her recovery. She and her husband indicated how grateful they were that someone contacted them, as they did not know what to do.