becky anderson

Insider case study:
Managing the most challenging patient in the hospital

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When Dr. Amy Shaheen was tasked with finding a way to keep her institution’s most troublesome patient happy and healthy at home, she was initially at a loss. She had treated the patient extensively for COPD, yet nothing seemed to work – the patient kept coming back to the ER time and time again.


It wasn’t until Shaheen took a more holistic approach that she began to see a reduction in the patient’s COPD readmissions. Watch as Shaheen explains how she ultimately found a solution for this pesky patient:

Amy Sheehan screenshot from video

I had the patient that had the single most admissions in the entire health care system. You know, I should be really proud of that. And it was embarrassing because I thought I was doing everything I possibly could to try to help this person who had COPD, was on oxygen and had 50 visits to the emergency room in a given year. Fifty. It’s insane.


I think that we're all struggling between when is it disease-specific and when is it not disease-specific.


And this is where we started our case management program and really started to – I said, there's these complex systems playing here. She's poor, she can't get from her site, she can only call an ambulance. That was her transportation when she felt bad and depressed, bipolar, diabetic, all of those other things.


Just a COPD navigator, that might not have worked for her, but having a social worker who actually called her literally every single day and every day would talk to her about alternatives to the emergency room: Have you ever thought about urgent care? You only have to wait 10 minutes instead of 7 hours? Have you thought about your medications? How can we help you manage your COPD medications better? Can we help you get your COPD medications? But ultimately, it was getting her depression medicines finding a therapist and a psychiatrist in our health care system.


And that patient has not been admitted or to the emergency room once in the last year.


I think that was a huge success story and really emphasized to me the need for case management. I kept treating COPD. I kept treating all of her other diseases with medications, but really, I think it was social isolation and just feeling overwhelmed and someone to hold her hand. And now, she gets a weekly check-in with a phone call. Literally, it was daily for a while, but, what monstrous, I mean, just, you know, huge savings to the health system. And for her, I think she's a much happier person not spending so much time in the emergency room.


Amy Shaheen, MD MSc

Medicine ProfessorDivision of General Medicine and Clinical Epidemiology, UNC

Director of Population Health Services, University of North Carolina School of Medicine


Tammy Stucki, RRT-ACCS

Amy Shaheen, MD MSc

Medicine Professor, Division of General Medicine and Clinical Epidemiology, UNC

Director of Population Health Services, University of North Carolina School of Medicine

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