b'Patient ExamplesPatient #1: 62-year-old maleA 62-year-old male has congestive heart failure (CHF) following amyocardial infarction five years ago. He is seen twice a year by hiscardiologist and quarterly by his primary care physician. He takesfour medications regularly. He is usually stable, but occasionallyhas episodes of shortness of breath. He tries to manage but is oftenon the edge. After calling both of his physicians offices, he followsthe instructions on the recorded messages, and comes to theemergency department. What happened in the ED and afterward:The emergency physician performs a history, physical, EKG and labs, administers a diuretic, and observes him over several hours. Emergent conditions were ruled out and he is feeling better. He was discharged home with a diagnosis of a mild exacerbation of chronic CHF. Follow up within 2-3 days was strongly recommendedsooner if worse.Unfortunately, the patient was unable to get an appointment with his primary care doctor for longitudinal management. Concerned, he returned to the ED in four days, and because timely specialist follow-up was not available either, he was hospitalized in observation status.What this visit reveals about the health of the health care system:In this example, the patient lives in a community with a relatively high incidence of CHF. The emergency department sees 100 patients a day, with an average of 25 admissions, 8-10 of which are CHF patients. Almost all the hospitals CHF admissions come through the ED.The communitys busy primary care physicians and cardiologists have trouble accommodating the frequent need for prompt follow up from this patient population. Noting this, the hospital implemented new interventions, including dedicated case management, disease management, and patient education. These options showed some promise, but all were hampered by the lack of 24/7 availability, the need for more frequent intervention, variable patient engagement, and high demand. Given the frequent contact of this significant CHF population with the ED, leaders considered ways to optimize the EDs role in the health care community. The hospital reviewed recent patient experiences, which showed a substantial opportunity for CHF patients to receive next-day assistance in obtaining a timely follow up visit, telephone follow-up, interval guidance from an emergency clinician via telemedicine, and occasionally, remote monitoring with physician oversight. With augmented staff, the emergency physicians filled gaps in home-based care, creating a necessary bridge to primary care. Preventable ED visits and hospitalizations were reduced, and patient engagement, satisfaction, and outcomes were improved.Together, we healTogether, we heal 124Together, we heal SCP HEALTHIFROM INSIGHTS TO INTERVENTIONS'