AT ASSUTA ASHDOD, CARE REFERRED IS CARE THAT OCCURRED
January 2, 2019
Author: Maayan Hoffman
Source: The Jerusalem Post
It was a Friday at 1:30 p.m., when a 31-year-old woman entered the emergency room of Assuta Ashdod Public Hospital. At 20 weeks pregnant, she was complaining of severe abdominal pain. She was examined immediately by an emergency medicine specialist, had an abdominal ultrasound and was diagnosed with a ruptured uterus with excessive internal bleeding in her abdomen, despite no external signs. By 1:45 p.m. she underwent a lifesaving operation. A few more minutes and she would have gone into hyperbolic shock.
“This is just one of many examples of cases where if a patient had to travel to a hospital outside of Ashdod, she wouldn’t have survived,” said Prof. Joshua “Shuki” Shemer, chairman of the new, cutting-edge Assuta Ashdod hospital, the first public hospital built in Israel in 40 years.
Before Assuta Ashdod opened its emergency room in November, Ashdod patients in need of emergency medical attention had to travel either between 40 minutes to two hours to other hospitals. Ashdod was the only one of Israel’s 10 largest cities without a hospital.
Shemer said the vision of Assuta Ashdod is to create a center of excellent integrated care: the deliberate organization of patient care activities between two or more providers – saving time, money and improving outcomes.
Practically, this means each doctor at the hospital can open his or her computer and in one electronic health record (EHR) see all the information on the patient for whom he or she is providing services. A case manager in the hospital coordinates patient care, from the ER to other hospital departments and, ideally, once the patient is discharged.
“You will see a continuous flow of information from the hospital to the insurance health funds and the community, including the welfare department and National Insurance,” Shemer explained, noting that to date only the Maccabi Health Services Group has integrated with Assuta Ashdod, but there are plans for additional collaborations.
This case manager can see gaps in care that could affect the health status of the patient and track his or her care team to help ensure the right individuals are involved in supporting the improvement of the person’s overall health. Using this system, doctors can more effectively track changes in a patient’s condition as the individual moves throughout the healthcare ecosystem. The closed-loop referral process will help ensure that care referred is care that occurred.
Shemer, who served as surgeon-general of the Israel Defense Forces, director-general of Israel’s Ministry of Health, and CEO of Maccabi Healthcare Services, is the brains behind Assuta Ashdod and its operations. He explained that generally when a hospital makes referrals out to larger community health fund providers or vice versa, the flow of important information is frequently mishandled or takes an inordinate amount of time to produce. He estimates that as many as 30% of all medical activities conducted in hospitals around the world are redundant or unnecessary, costing the system money. Individual patient care suffers, and community health is reduced. The Assuta Ashdod Hospital model, by contrast, takes a comprehensive, whole-person approach to care.
“This model will save the health care system a lot of money and result in better outcomes for our patients,” Shemer said.
“Your vision is my vision,” said Prime Minister Benjamin Netanyahu at the hospital’s ribbon-cutting ceremony late last year.
To turn Shemer and the prime minister’s collective dream into a reality, Assuta Ashdod had to recruit a 750-strong medical staff in a country where not a single nurse or physician is unemployed. The hospital filled its team with medical personnel who were inspired by the hospital’s innovative outlook and drive for international standards. Many staff members are commuting from the center of the country.
Additionally, doctors and nurses have come from abroad, including from North America, Brazil and France.
“It’s a veritable kibbutz galuyot, a biblical gathering of medical talent and vision,” said Shemer, who noted it has been “a kind of miracle” to gather these diverse medical professionals together and amalgamate them into a team, as well as teach them to use Assuta Ashdod’s EHR and other digitized systems. Some 80 percent of activities at the hospital are already digitized, something to which staff from most Israeli hospitals are not accustomed.
Daniel Peterman is an Emergency Department doctor who made Aliyah seven months ago from Brazil specifically to work at Assuta Ashdod. He said he was drawn by the vision of his boss Debra West, who heads the hospital’s Emergency Department. Peterman said Assuta Ashdod’s ED embraces innovation and creativity and draws on models of care adopted and adapted from overseas that will help optimize flow through both the Emergency Department and the rest of the hospital to reduce overcrowding and waiting times.
The Emergency Department is not divided into surgical, internal medicine and orthopedic departments, as is traditionally seen in Israel. Rather, all patients are seen in the same treatment areas and cared for by the same staff, divided according to urgency alone.
Peterman said going to work is “fun for me” because “I look forward to the good energy in the place.”
Most exciting for Peterman has been Assuta Ashdod’s paper-free concept, which he said ensures patient documentation is never disorganized or lost, one of the biggest challenges he saw in other emergency departments. Further, each senior doctor is assigned a medically trained scribe who works alongside the physician, takes electronic notes and processes orders on behalf of the doctor so that he or she can focus more on patient care.
Beyond being cutting-edge inside the hospital – and the area’s teaching hospital, tied to Ben-Gurion University of the Negev – the hospital is likewise pioneering in its construction.
The hospital’s 750,000 square feet physical facility – a nine-floor inpatient hospital building and a seven-floor outpatient clinic, connected by a four-story, light-filled entrance lobby – is Israel’s first fully rocket-proof hospital, built with a unique bomb-shelter designed to withstand missile attacks. It is also chemical and biological weapons-proof.
During Operation Protective Edge in 2014, some 230 rockets rained down on the city of Ashdod, which is located only 25 miles from the Gaza Strip. In the event of another Protective Edge or other major attack, “we could continue to work without evacuating a single patient – everywhere in the hospital, from the Emergency Department, to the operating rooms, to all the wards,” Shemer said.
When building the hospital, special attention was also paid to being environmentally conscious. The facility meets voluntary Israeli green building standards for design, construction materials, and heating and cooling systems. A healing garden offers patients and their visitors respite.
Finally, Shemer said, Assuta Ashdod focuses on the dignity and privacy of its patients. One-third of the rooms are private, and the other two-thirds allow only for double occupancy. In the emergency department, beds are separated by walls instead of curtains to maximize privacy and help deter the spread of infection.
At the ribbon-cutting ceremony, Netanyahu said he hopes to add an additional 500 beds in the protected underground areas of the hospital and to build a landing pad for helicopters. Shemer said the latter is already happening.
Shemer said when the team opened Assuta Ashdod they did not realize how hungry for healthcare the residents of Ashdod really were. Shemer said requests for medical treatment at the hospital are very high compared to in other regions, likely because before the hospital opened, Ashdod residents would have had to drive so far for care that they neglected their healthcare needs. Since opening the maternity ward around six months ago, the hospital has delivered more than 2,300 babies.
“Assuta Ashdod is one of the most important modern Zionist projects in Israel and the most dramatic event in the Israeli health system in decades,” said Shemer. “For the residents of Ashdod, it is revolutionary.”
Appeared in The Jerusalem Post