Seamless Transition — Continuum of Care

Enhanced communication promotes the best outcomes and value in health care when patients transition from clinic to hospital and back again.

When Assistant Professor of Medicine James Woodrow, MD, saw Charlotte Fedanick in the COPD Exacerbation Clinic at National Jewish Health, he decided she needed to be hospitalized for her rapidly worsening COPD. By the time Charlotte’s daughter had driven her two miles to National Jewish Health | Saint Joseph Hospital, hospitalist Carrie Horn, MD, had already talked to Dr. Woodrow and reviewed Charlotte’s chart.

“It was quick,” said Charlotte. “They took care of all the paperwork. They knew me. It was wonderful.”

With the opening of the new hospital in December 2014, physicians from both institutions began actively working together. The collaboration has enabled physicians to deliver the full range of care, from clinic to hospital and back again, in a seamless manner. With National Jewish Health hospitalists admitting and caring for National Jewish Health patients, the transition from clinic to hospital is smooth. The hospitalists can review patients’ electronic health records before the patients arrive. The hospitalists also know most of the physicians sending patients to the hospital, how they like to practice and how to keep them updated on a patient’s status.

Charlotte’s pulmonologist, Amen Sergew, MD, received regular updates from Dr. Horn, then saw Charlotte for a follow-up shortly after Charlotte left the hospital. “The communication and updates help tremendously,” said Dr. Sergew.

“I got a team that knows what I am about,” said Charlotte. “National Jewish Health and Saint Joseph working together is great.”

Clockwise from the upper left: James Woodrow, MD, Carrie Horn, MD, and Amen Sergew, MD, provided a seamless patient experience for Charlotte Fedanick, pictured center.