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Hospital Coaches Frequent E.R. Users To Improve Care, Reduce Costs

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(Sacramento, CA)
Monday, April 2, 2012

Learn more about Capital Public Radio's upcoming documentary An Ounce of Prevention here

Wendy Martinez deals with health crises all day long. Sometimes, the same one over and over again. Today she's at the hospital, on her way to visit a patient who overdosed on methamphetamines and then had a stroke.

MARTINEZ: "She'll probably be restrained because of her brain injury. At times it seems like she's connecting, and then she'll fade out."

Wendy is not a doctor. Her job title is outreach specialist. She helps high needs patients who often show up at Kaweah Delta Hospital's emergency room in Visalia. Her job is to get them stable and connected with other care.

MARTINEZ: "How ya doing?"

(Doreen speaks unintelligibly)

Her client today, whom we'll call Doreen, was severely disabled after her overdose. Her speech is a mumble. She can't eat by herself and she's incontinent.  When Wendy talks to her, Doreen's dark brown eyes wander.

MARTINEZ: "Tell me again?"

(Doreen speaks unintelligibly)

MARTINEZ: "I can't understand you. I'm sorry. I'm trying"

Doreen lies on the bed, emaciated. Her hands and ankles are tied so she can't wander off. She needs round the clock care. She's been in and out of the hospital repeatedly for months. This time, wearing a soiled diaper when she was dropped off by a friend.

MARTINEZ: "Was she feeding you? And changing you? Keeping you clean?"

(Doreen speaks unintelligibly)

MARTINEZ: "Because you know, that's my job, I want to make sure that you're ok. That's why I'm here. And we're going to try to find a place for you to go next. Ok? A place where you can live."

Most days, Wendy deals with clients who have better prospects. On this day, she also saw a patient with an antibiotic-resistant blood infection who's waiting for a liver transplant and she dealt with a man with diabetes who stopped eating in a bout of depression. She works with patients outside hospital walls connecting them to social and medical services, and making sure they follow through with their care. 

MARTINEZ: "We're preventing them from getting stuck in that same cycle of ending up in the hospital with no education, with no resources... In the process that we're advocating with them, we teach them to advocate for themselves." 

TYNDAL: "It's a lot more of being a life coach if you will."

John Tyndal says it takes compassion to do this job. He manages The Bridge at Kaweah Delta - the outreach program for people who have used emergency rooms at least times in a year. Tyndal says hooking them up to public services can make them self sufficient, and their care less expensive.

TYNDAL: "We've worked with many individuals that we've connected them to various resources throughout the community and it's really been a turning point in their life. We have a couple patients who when we started working with them, they hadn't graduated high school. But we got them connected to drug rehab, got them connected to a primary care provider." 

The California Department of Health Care Services says increasing enrollment to Medi-Cal could result in higher costs. But one study showed a 50% reduction in emergency room visits among Bridge clients a year after they started. That's good for the hospital's bottom line, and it brings down the ER cost to Medi-Cal, too.

(Sound of Wendy with Doreen)

But Bridge workers like Wendy don't think about the money. She's getting her client Doreen qualified for Medi-Cal so she can get full-time care in a nursing facility. It will take a few months.  In the meantime, Wendy gets through the difficult day-to-day situations with compassion, patience, and a little bit of humor.

MARTINEZ: "Did you have a good lunch?"

(Doreen speaks unintelligibly)

MARTINEZ (Laughing): "I got that part. That's what they say about hospital food, huh?"

Pauline Bartolone, Capital Public Radio News.

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