Dual Training and a Discharge Clinic

A common question facing those considering a combined program in emergency medicine and family medicine or any combined field is simple: Why? Everyone has a different answer to that question. Initially, I pursued a combined program with the intention of providing complete care in a rural setting, believing that the dual training would allow me to manage a patient’s day-to-day healthcare as well as respond to emergencies as they arose. As the years of residency and life in general continued, my goals changed - as did my career.

I initially took a full-time emergency medicine position and continue to work in this capacity. My family medicine training has helped me in several ways; one such way is identifying areas where care can be improved in the transition from the ED to the outpatient realm. To that end, I have successfully designed and started a geriatric discharge clinic for patients over the age of 60 who are discharged from the ED. This was accomplished with the cooperation of both the emergency medicine and family medicine departments at Christiana Care.

The goal of the clinic is to assure that patients discharged from the ED can be seen by an outpatient provider within an appropriate time frame. Our current model is ideally suited for patients over the age of 60; however, we are currently extending these clinic visits to patients of all ages in need of follow-up care. Clinic time is also utilized for urgent-care type visits for patients unable to gain access to a rapid visit with their primary care providers. The clinic is still in its infancy, but we believe that adding these healthcare resources to our community will benefit our patients and ultimately decrease ED utilization and readmission rates for these patients.

All patients over the age of 60 discharged from the Wilmington ED are screened for participation in our clinic. A registered nurse from our emergency nursing staff calls these discharged patients to assist with follow-up related outpatient needs, such as follow up appointment scheduling with their primary care provider, specialists, or coordinating with case management and social work staff to address other home care needs. Response to the nursing callbacks has been very well received by the notified patients thus far. Feedback from these callbacks is then relayed to the ED providers by the nursing staff when applicable. Data collection is ongoing and we are currently attempting to optimize the clinic’s effectiveness, but initial results seem promising.

The dual training I received in both emergency medicine and family medicine has been integral to allowing me to pursue my goals in both specialties, and to bridge the gap between the emergency and outpatient realms. It has given me a unique perspective that allows me to make positive changes and aid our surrounding community in achieving their healthcare needs. A combined program in emergency medicine and family medicine will provide you with invaluable tools to make an impact as well.

Ellen Finney, MD is dual-boarded in Emergency Medicine and Family Medicine. She trained in the combined EM/FM program at Christiana Care in Newark, Delaware and is currently working as a full-time Emergency Physician for Doctors for Emergency Services in addition to being part time faculty with the Christiana Care Family Medicine Department.

Ellen Finney, MD