Connecting The Dots of Healthcare

Bill Langley attended the our recent three day conference for training and certification of the homecare sales professional designation in San Antonio. He asked me to share with a colleague my AD Van Disselt concept. I thought others might also appreciate the concept.

How do you get physicians to recognize the value homecare provides both physician and patients? Do you, as asked of me by a homecare corporation in a training program, give physicians a laundry list of “what homecare can do?”

If so, they’re asleep by the first opening volley. Let’s look at this from a different perspective.

First, why do physicians admit patients to a hospital? Why do we keep them another day, “just to be safe,” before ultimate discharge from the hospital. Well, we keep them in the hospital to keep an eye on them. To “observe” them in an inpatient setting. Do we as physicians keep them under observation? Hardly. we put them in the hospital so the NURSES can observe them. So when we admit patients, we put them in a hospital to keep them under the watchful eye of nurses and other healthcare professionals. Sure, we visit them, but unless they’re really critically ill, we don’t do much “observation” other than a few minutes a day.

When a patient is discharged from the hospital, what do we write? “D/C to home?”

Have you ever wondered why our discharge orders from a hospital are so… well, disjointed? The reason is because by the time the discharge occurs, they’re not, well, sick enough to keep in the hospital. So it’s of relatively little consequence and the orders are rather perfunctory. But in contrast, admission orders are typically more complete and detailed. Well, the patient on admission is “sick” and it’s more important to get everything just right.

Do you ever wonder why physician hospital admission orders are so relatively organized and similar?

It’s because we know our friend, AD Van Disselt. AD is a mnemonic that physicians learn in medical school when we first start writing orders. It’s a convenient way to remember the types of things we need to, uh, remember.

Here’s how it goes.

Admit
Diagnosis
Vital signs
Activity
Nursing
Diet
IV’s
Supportive meds
Symptomatic meds
Emergency
Labs
Tubes

Now, use the laundry list of “things homecare can do” and see if you can’t fit them all into the AD Van Disselt mnemonic. They all neatly fit and are easier for a physician to THINK of when they are writing orders.

But evidently not discharge orders.

So get your physicians to stop discharging patients from the hospital and get them to start ADMITTING PATIENTS TO HOME.

In a similar manner, physicians often still need observation of patients, even when home. And through routines, just like in hospitals, homecare nurses can fill the need for necessary observation.

When you ask a physician to use the same mnemonic that they probably use to admit to a hospital, to admit to home, they will see opportunity to engage homecare services. This works because when they run through the AD Van Disselt litany, they will see opportunities to continue a higher level of patient care for their patients than simply “discharging to home.”

When homecare can change the mindset of physicians to “admit” to home, rather than “discharge” to home, patients will receive better care and encounter fewer bounce backs to the hospital, and physicians will perceive homecare as a high quality adjunct to their own care.

Get your physicians to stop discharging, and start admitting, patients to home.