HEALTH Doctor visits patients at home in early discharge program BY KATHY RICKETTS Gazette Reporter
After a week in the hospital for pneumonia, June Coyne, 75, was anxious to go home. But once she got there, the West Sand Lake woman realized there were several questions she had forgotten to ask her doctor. Not to worry. Because of the new Early Facilitated Hospital Discharge Program at Albany Medical Center, Coyne had an opportunity to ask Dr. Kevin Costello all of her questions — and then some. Launched in January, the program is designed to follow patients between the time of their hospital discharge and their first follow-up visit with their primary care physician. “Often, when patients are discharged, they are sent home with newly prescribed medications, diets or disabilities, which can create further stress,” said Costello, who generally visits patients the day after they are discharged for about an hour and a half. “We are working to ease this anxiety by bridging the crucial time period between when the patient leaves the hospital and visits their primary doctor, in an effort to lower the rate of re-admission.” Subsequent visits are made as needed for two to four weeks, or until the patient sees their primary care physician. During that time, Costello communicates regularly with the patient, primary physician and hospitalist (a physician who cares for patients in hospitals), keeping everyone up to date on the patient’s condition. The program is a collaborative effort between the Albany Med hospitalist program, case management, the department of medicine and the Visiting Nurses Association of Albany. During his visits, Costello performs a wide range of procedures to ensure that patients are not suffering from adverse side effects of medications or complications from surgery. He answers patients’ questions, checks their vital signs and prescribes medication when needed. “Dr. Costello answered all of my questions,” said Coyne, a widow who writes all her questions in a notebook. “Having him come visit me was wonderful. Once the hospital releases you, you don’t see your own doctor for a couple of weeks, and you’re kind of in limbo. You’re not always sure what to do. He was a big help.” Coyne, for example, was unsure how often she should use her walker. Costello told her she should use it as much as possible to make sure she didn’t fall. GETTING WORD OUT So far, 21 patients have been admitted into the program. “Referrals have been slow in coming just because people aren’t familiar with the program yet,” said Costello. “But we are gradually getting the word out there more and more.” If doctors are unsure of what a patient’s follow-up is going to be, they may be hesitant to release the patient from the hospital, especially if the patient lives alone, said Costello. “The longer patients stay in the hospital, the more they are at risk for hospital-related complications such as muscular weakness, falls, skin breakdown, pneumonia and constipation,” said Costello. “They are better off at home in their own environment, especially if there is any degree of cognitive impairment.” Costello also makes sure the primary care doctor knows of any changes in the patient’s condition. While available to all patients, the program primarily is used by elderly patients who have been admitted to Albany Med with an acute or chronic medical condition. Enrollment in the program occurs when a physician, social worker or case manager identifies a patient who is ready for discharge. Costello, who sees about fi ve patients a day, will assess the patient in the hospital, notify the hospitalist and primary care physician of the patient’s entry into the program, collect the patient’s discharge summary and review all prescribed medications. GLAD TO BE HOME Coyne said she has spent quite a bit of time at Albany Med the past few years. In 2000, she learned she had non-Hodgkin’s lymphoma. She had radiation and chemotherapy, and is in remission. On May 25 of this year she had back surgery, and on June 23 she had open-heart surgery to repair leaky valves. “I hope to stay away from that place for awhile,” Coyne said with a laugh. On a recent afternoon, Costello was making his second visit to see Coyne. “How are you feeling today, Mrs. Coyne,” Costello asked. “Pretty good, except I had leg cramps last night,” Coyne answered. Costello drew blood to check Coyne’s magnesium, calcium and potassium levels, and told her if they were low, they could be provoking the muscle spasms in her legs. “How’s the breathing going after the pneumonia?” he asked. “Fine,” she answered. “The cough seems to have settled down.” “Are you up and about most of the day and using the walker?” he asked. “Well, I’m not using the walker that much,” she answered. “I don’t really need it.” “I’d probably stick with the walker for now,” said Costello. “You don’t want to fall, especially if you are alone.” Costello asked several more questions before listening to Coyne’s chest and back, and taking her vital signs. “What I like best about this program is you get answers to questions you don’t think of when you are in the hospital,” said Coyne. “And when you are with your primary care doctor, you don’t have that much time. I think this is a wonderful program.” ANA N. ZANGRONIZ/GAZETTE PHOTOGRAPHER Dr. Kevin Costello from the Early Facilitated Hospital Discharge Program at Albany Medical Center takes a blood sample from June Coyne at her West Sand Lake home. ANA N. ZANGRONIZ/GAZETTE PHOTOGRAPHER June Coyne breathes deeply as Dr. Kevin Costello listens to her lungs at her West Sand Lake home.
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