Caring for patients at KEMH

Tuesday 15 October 2024: Bermuda Hospitals Board has posted a frequently asked questions (FAQ) on its website that explains how patients are cared for and by whom at King Edward VII Memorial Hospital (KEMH).

CEO & President Scott Pearman says: “We want to demystify as much as possible how care works at KEMH. BHB follows the same quality standards as the UK, US, and Canada, with inpatient acute care led by onsite hospitalists on our acute care inpatient units, with other specialists leading in critical and emergency care units. We often get questions from patients about their inpatient care, especially about the role of their general practitioners (GPs) while they are in the hospital. We hope the factsheet posted on our website will help.”

Acting Chief of Medicine and Director of the Hospitalist Programme Dr Nevin Williams explains: “A common question is about the role of a patient’s GP while they are in hospital. In KEMH, a patient’s care is led by the ‘most responsible physician’ (MRP) and this will be the main contact for the patient and family. At KEMH, your most responsible physician may vary depending on the area you are in, but it will always be an on-site physician specialist with the most appropriate training for your care.”

• In the Emergency Department, the MRP is an emergency physician.
• For a patient admitted after planned surgery, the MRP will be the surgeon.
• Patients admitted to an inpatient unit from the Emergency Department will have a hospitalist as an MRP.
• If a patient becomes critically ill and is moved to the Intensive Care Unit, the MRP will be one of the anaesthetists trained in critical care.

Click here for a factsheet and click here for a short animation about the role of hospitalists on the inpatient acute care units.

The MRP directs the clinical team of nurses, allied health staff (such as physiotherapists and dietitians), and other doctors who might need to advise on a patient’s care, like a cardiologist (heart specialist) or geriatrician (a specialist in senior care). A BHB physician is only the MRP while the patient is in the hospital.

Dr Williams continues: “There are over 3,100 inpatient acute care admissions to KEMH each year, mostly cared for by hospitalists. Hospitalists are doctors with special training in internal medicine and hospital care. They are on site 24/7, so they can quickly respond to any sudden issue a patient experiences.

“The hospitalist’s key focus is providing acute care until a patient is discharged home to their GP. For over 60% of our patients, the hospital stay is under seven days. The relationship between the hospitalist and GP is therefore very important. The patient’s GP is notified by email when the patient is admitted to an inpatient acute care unit under a hospitalist’s care and information is sent when they are discharged to ensure patient care is coordinated when they leave the hospital. We are working to improve this communication, especially using our electronic medical record, PEARL.”

Chief of Family Practice Dr Burton Butterfield, the GP representative on the BHB Medical Staff Committee, acts as the link between community-based GPs and BHB.

Dr Butterfield explains: “As GPs we know our patients well since we see them over long periods of time. Our expertise is in caring for patients with illnesses and injuries in the community, managing chronic illnesses, and knowing when a patient needs hospital care or a specialist. It is important that GPs get timely and accurate information when a patient is admitted. We may speak with the hospitalists in cases where our understanding of the patient’s history may help in making decisions, but most critical for us is getting the discharge summary so we can smoothly coordinate the patient’s care back in the community.”

Dr Williams notes: “BHB is responsible for sending a patient’s discharge summary to the GP listed on the patient’s admission file, but it’s very important patients confirm their most current information, including their primary GP. They should do this when they come to the Emergency Department or are admitted. It is not uncommon for members of our community to sometimes have more than one GP or change their GP over time. Making sure we have the right details ensures the information goes to the right GP.”

Currently, GPs receive BHB discharge summaries by fax, email or by having read access to the BHB electronic medical record, PEARL. BHB is planning to follow the lead in the UK by discontinuing the use of fax in the future due to issues of reliability and confidentiality . This requires collaboration between BHB and community physicians. The chief medical information officer position, held by Consultant Anaesthetist Dr Simon Morton, is being expanded to lead the work required, and a physician committee that includes GPs is already meeting to help optimise the use of PEARL in sharing secure and confidential patient information.

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