I have worked directly with Emily for the past eight months since I began practicing at UMCB, and I can personally attest to her compassion, strong work ethic, and admirable patient-centered contributions.
Recently, Emily and I were involved in the care of S, who presented to our hospital with a stage IV sacral ulcer secondary to immobility from a long-standing diagnosis of multiple sclerosis. S could communicate only with soft whispers, and he could only eat when fed with assistance. He had little to no movement in his extremities, and his physical limitations meant he could only spend his days watching television instead of playing with his young child. He suffered from severe opiate-induced constipation, dysphagia resulting in muscle wasting and cachexia, and neurogenic bladder requiring suprapubic catheterization. To share that this patient had a difficult life would be an understatement.
S was initially admitted for a surgery to repair his sacral ulcer. Patients who undergo this procedure typically remain at UMCB for 28 days. Unfortunately, S experienced several clinical and systems-based complications resulting in a length of stay of over 70 days.Throughout his hospitalization, his case was followed by Emily, who undoubtedly facilitated our patient receiving optimal care and a safe discharge.
Perhaps what is most memorable regarding Emily's performance in this case was the way she handled a seemingly countless number of discharge hurdles towards the end of his hospital stay. The medical needs of this patient were plentiful and complex. He had several surgeries while at UMCB and had multiple poorly-healing abdominal wounds, greatly increasing the risk for post-discharge complications. Ideally, S would have been discharged to a long-term acute care facility. His limited insurance, however, did not provide for this. The options remaining were to discharge him home in the care of his mother with assistance from a home health agency, or to a skilled nursing facility. The patient and his family adamantly refused the latter.
Emily worked tirelessly for several weeks to find a home health agency, placing dozens of phone calls and submitting numerous referrals. With intense focus, she was able to find an accepting organization, and she worked extremely hard to ensure the company was kept informed about S's condition and projected discharge date.
At the eleventh hour, as we were preparing to discharge the patient, the home health agency backed out. They claimed that they no longer had an attendant available for his case. This setback began what resulted in a three-week delay of S's discharge. I recall having the conversation with Emily when we were notified of the agency's reversal. She was upset and frustrated, not because of what may have been wasted effort in setting up the home health, but rather knowing that the patient would remain in the hospital when he didn't truly need to be, increasing the likelihood of further complications.
Unfortunately, the patient did experience additional impediments over the course of the next several weeks as Emily worked with persistence to arrange a safe discharge. His wound care needs became increasingly complicated and frequent. Despite this, the family still refused transferring him to a skilled nursing facility. As such, Emily diligently pressed on through several barriers to find another accepting agency. After about a week, she was successful and we again began preparing the patient for discharge.
At the very last minute, the second home health agency reversed their decision as well, stating that they re-evaluated S and now felt his case was too complex. In discussing this with Emily, her empathy for S was palpable. While quite disappointed that we had hit yet another road block in his discharge, she still managed to maintain a smile and a "we can fix this" attitude.
At this point in the hospitalization, S's complications had progressed to the point where going home with home healthcare was a safety concern. The patient and his family, however, still refused the idea of a skilled nursing facility. I attempted to counsel them to the contrary but was not successful. The medical team had accepted the fact that the patient would go home, knowing that this would likely contribute to further adverse consequences for S, but feeling as though we had no other choice.
I vividly remember discussing the medical team's opinion at the daily discharge huddle. Emily boldly and sternly argued her case in a room full of colleagues that it would be a disservice for this patient to go home. She then proceeded to spend several hours trying to reach the patient's mother by phone and provided extensive advising to the patient and family. In an effort well beyond the call of duty, she continually encouraged the family to accept a skilled nursing placement, and they ultimately agreed.
When everyone else on the care team had essentially given up on pursuing what was a truly optimal discharge plan, Emily dug her heels in the sand and would not take no for an answer. She was an exemplary patient advocate, and S's clinical outcomes were greatly improved as a direct result.
Not only was Emily fantastic within her role as a case manager, she also contributed to S's medical care while in the hospital. She reviewed the daily clinical progress notes and often personally followed up with consulting services including wound care and general surgery to ensure that tasks were completed in a timely manner. One of S's complications was wound dehiscence from his colostomy placement. The surgery team placed plastic retention sutures for wound healing purposes. Emily called the surgery team on multiple occasions to ensure that these special retention sutures were still indicated, and to solidify a plan for their follow-up and removal after discharge.
What I can't stress enough is that S's case is one of many examples of how Emily strives to deliver care on a daily basis. She possesses a fantastic knowledge of the healthcare system and utilizes this as a foundation to help not just the patients she is following, but also by sharing her wisdom with colleagues. In fact, it is often soft-spoken Emily who keeps our discharge huddle group reigned in and on-task. I have often relied on Emily's thoughtful understanding of the "big picture" to help guide medical decision making. Emily's notes and documentation are thorough and complete. In preparing this nomination, I reviewed all of Emily's notes pertaining to S, totaling over 13,000 words which provided a clear understanding and appreciation for the intricacies of S's care.
Case management is a critical, yet often overlooked, part of our care delivery at UMCB. Emily is an essential member of the team. She wholeheartedly embodies the mission and values of the DAISY Award including service, kindness, and integrity.
Emily is highly deserving of this recognition.