Patient Care

Outpatient Care

In conjunction with Dr. Jagruti Shukla, Director of Primary Care for the Los Angeles General Medical Center, Dr. Josh Banerjee and Dr. Barbara Rubino, members of the Division—including GIM section head Dr. Arek Jibilian—have worked to establish team-based care in the resident continuity clinics, where faculty provide direct patient care and supervise residents in providing care to over 35,000 patient visits a year. This effort improved patient experience as well as physician and staff satisfaction. Faculty also provides comprehensive care to the elderly population in the Geriatric Clinic, which receives approximately 4,000 visits per year.

The faculty members have been key partners with Dr. Shukla in building a resident continuity clinic modeled as a Patient Centered Medical Home (PCMH). This type of clinic redesign allows for improved access, continuity, care coordination, chronic disease management, preventive care and population management. Lessons learned from the previously instituted “Galaxy” model of care are being built into the PCMH model. Other enhancements include patient empanelment for the patients seen by over 170 resident physicians and improved telephone access for empaneled patients in adult primary care clinics.

Faculty members continue to work with pharmacy, nursing, information systems and hospital information management to develop a multidisciplinary approach to numerous medical problems such as Type 2 diabetes mellitus, congestive heart failure, and chronic pain. Workgroups continue to meet regularly to refine the approach to managing these more challenging subsets of patients.

Inpatient Care

The Hospital Medicine Program consists of the General Medicine Service, the Medicine Consult Service, and the Medicine Blue Service. The General Medicine Service is made up of 12 teaching teams staffed by residents and led by a teaching faculty member. The Medicine Blue Service is composed of four non-teaching teams staffed by nurse practitioners who are supervised by a faculty physician.

The Hospital Medicine faculty members continue to work with facility leadership and other departments to develop initiatives aimed at decreasing length of stay, improving operational efficiency through refining patient flow, improving inter-departmental communication, reducing denied days, and optimizing the utilization of limited inpatient resources. In addition to their clinical responsibilities, this same group of faculty provides educational workshops for medical students at the Keck School of Medicine of USC, one of the most highly regarded workshops by the medical students.

The Medicine Consult Service provides ongoing medical care to those inpatients on surgical services, evaluates patients for transfer to Los Angeles General Medical Center and facilitates the flow of patients within the hospital. This service continues to actively work with hospital leadership on improving transitions of care. It is involved in the care of patients during the admission process as well as during the transfer of patients in and out of the Medical Intensive Care Units, Coronary Care Units, and Medicine Ward. The Blue Service has an average daily census as high as 70 patients. Care is provided by teams of nurse practitioners, faculty physicians, nurse care coordinators, and social workers. The Blue Service continues to help improve compliance with resident duty hours and works with administration to manage complex placement issues for the patients.

Adult and Pediatric Palliative Care

The Palliative Care patients are seen in all inpatient units of the hospital, from the Emergency Department, all active medicine-surgery wards and ICUs to the NICU, Pediatric ICU and Specialty ICUs. The Palliative Care team continues to benefit from other faculty including Dr. Aaron Storms and another new hire, Dr. Sunita Puri. The team continues to include two dedicated nurses, a chaplain, a nurse practitioner and a social worker to support the inpatient consult team. An outpatient service is expected to relaunch next year.

Private Practice

GHPGIM faculty conducted 31,500 private practice patient visits during 2016. The Division continues to have robust annual revenues, passing the $4 million/year mark, emanating from the practice. In addition to core facility, located in HC2 on the Health Sciences Campus, patients are seen in satellite locations including Keck Medicine of USC- Downtown Los Angeles, La Cañada Flintridge, Beverly Hills, Pasadena and University Park Campus. The geriatric physicians see patients at several long-term care facilities. All inpatients are admitted to Keck Hospital of USC (KH), where the Division’s average daily census continues to grow.

The Section of Adult and Pediatric Palliative Care continues to grow and to see inpatient consults at both the Keck Hospital and the Norris Cancer Center. They have begun to see outpatient consults as well, in partnership with Hematology and Medical Oncology faculty. The Palliative Medicine and Supportive Care Team is led by Dr. Sunita Puri. The team includes an NP, a social worker, a care coordinator and a data assistant. They expect to recruit additional faculty in 2017. The Palliative Care Section provides extensive core training and educational support in pain and symptom management and communications skills for Keck medical students, residents and fellows across multiple academic departments within the USC health care system.

Hospital Medicine Program

The Hospital Medicine Program (HMP) at KH, headed by Dr. Michael Wang, allows for 24/7 onsite faculty inpatient coverage and resident supervision, staffing at the Evaluation and Treatment Center (ETC) and rapid response coverage for the hospital campus (Rapid Response Team). The HMP faculty members also play vital roles in quality initiatives, utilization management and clinical care. They assisted in lowering the length of stay for Joint Replacement patients over the past few years. In addition to orthopedic tumor patients, they expanded to provide co-management for Spine Program patients, Heart Failure patients, and set the groundwork for co-management of Payor-based patients. During the last fiscal year, GHPGIM Division was the leading provider of patient services in the ETC. Lastly, members of the program have been actively involved in a variety of quality improvement activities, such as Throughput, VTE prevention, heart failure quality measure compliance, KeckCare improvement, and hospital acquired infection prevention.

Electronic Health Record System

USC has implemented Cerner to update and transform the electronic health record (EHR) system at Keck Medical Center of USC. The hope is to improve medical care and communication, reduce errors and provide for a unified system that maintains or enhances functionality. Under Dr. Michael Karp’s leadership, monthly departmental meetings are organized in an attempt to coordinate these efforts. Representatives from the Division are active participants in the twice monthly interdepartmental EHR subcommittee (co-chaired by Edward Lee and Mike Wang) and in the implementation of the EHR in both the inpatient and ambulatory sectors. During this past year, Allscripts was retired, Patient Portal content was improved, sepsis interventions were instituted, forwarding documentation to external physicians was enhanced, and the platform for documentation, ordering and clinical decision support has made incremental gains.