Staying On Track Through the Stay Healthy Clinic

Being admitted to the hospital can be a frightening experience for some but for others, leaving the hospital causes more anxiety.

While in the hospital, a team of health care professionals monitors a patient’s condition hourly and, at times, even more frequently. They provide care, guidance, instruction and support for each individual’s specific health needs.

But when a patient leaves the hospital, they may not have a strong support system in place to keep them on track to reaching their optimum level of health. If they don’t take their medication, improve their diet or get check-ups, they might end up back in the hospital or the emergency room.

The new Stay Healthy Clinic at Barnes-Jewish Hospital, which opened in September 2011, is designed to fill the gap when a patient needs help staying on the right track. Patients who are identified during their hospital stay as vulnerable—they have a diagnosis of heart failure, pneumonia, chronic obstructive pulmonary disease (COPD) or have had a heart attack and their social situation puts them at risk to return—are given an appointment in the clinic within a week of their initial discharge. Transportation and cab vouchers are available for the return visit.

Henish Bhansali, MD, a Washington University physician who runs the clinic, reviews each patient’s record thoroughly to understand what happened during the hospital stay. He and nurse practitioner Kelly Dodds, RN, ANP-BC then meet with the patient to see if the patient understands and has been following discharge instructions, verify all of their medications and answer any questions.

On a recent visit, Barbara Buckley discussed symptoms that she had been experiencing with Dr. Bhansali. Buckley suffers from a heart condition that has caused her to be hospitalized more than once. In addition to the Stay Healthy Clinic, Barnes-Jewish has launched several programs to reduce patient readmissions. In some instances, nurses make home visits to released patients, helping them to set up pill boxes and coordinate their medications. The clinic could eventually see up to 50 patients a week for follow-up appointments.

After addressing any lingering concerns from a patient’s hospitalization, the goal of the clinic is to connect each patient with a medical home, such as a family physician. “We have the chance to spend a lot of time with patients at the Stay Healthy Clinic, so we can truly get to the core of not only their medical issues but also their social issues. This is the part that I feel has the strongest impact on their overall medical care and outcomes,” says Dr. Bhansali.

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