Preparing for different professions, working toward a common mission.
Hotspotting teams introduce student participants to peers from many disciplines and help nursing students better appreciate the perspectives nurses bring to collaboration.
Even the most dedicated nursing students wonder, at times, if they’ve chosen the right profession. I chose to become a family nurse practitioner because I want to work in primary care helping people establish happy, healthy lives in an affirming and sustainable manner. While I enjoy learning to be a clinician, there are days I think being an attorney would be interesting. Other days, I think being a social worker would allow me to help people achieve their goals of happiness and health—or, if not a nurse, attorney, or social worker, maybe a pharmacist or economics researcher.
Different professions, all working toward a common mission—that’s why I value the opportunity I’ve had to help establish Atlanta’s Interprofessional Student Hotspotting Collaborative. It has allowed me to explore the range of what can be considered “nursing” while seeing strengths that people from diverse disciplines can offer as team members.
Recognizing the benefits of interprofessional education has been incidental for me—a by-product of my involvement with hotspotting. I was initially attracted to building the collaborative because of its potential impact on patients.
For high utilizers of healthcare
What is hotspotting? It’s an approach that utilizes interprofessional collaboration to provide better care for high utilizers of healthcare services. For Grady Hospital in Atlanta, Georgia, USA—Atlanta’s public hospital—high utilizers (sometimes called “super utilizers”) constitute 5 percent of the hospital’s patients but contribute to 50 percent of its healthcare costs. Often, they have complex chronic conditions, such as congestive heart failure or end-stage renal disease, that require careful monitoring of daily medications and lifestyle factors. High utilizers may also have comorbidities, such as mental illness. In addition, they often reside in low-resource settings, making management of chronic conditions difficult.
The Interprofessional Student Hotspotting Learning Collaborative in Atlanta is an affiliate of a national initiative established by the Camden Coalition of Healthcare Providers. The program is hosted by the Association of American Medical Colleges, Primary Care Progress, National Academies of Practice, Council on Social Work Education, and American Association of Colleges of Nursing. Atlanta’s student hotspotting team works with high-utilizing patients at Grady Hospital on non-medical matters that contribute to frequent hospital usage. In seeking to reduce frequent hospitalization, the students learn about and address barriers to health management that cause it.
While the national initiative began in 2014 and is now in place at about 20 universities, the program is new to Atlanta. The Atlanta team is sponsored by the Healthcare Innovation Program/Georgia Clinical and Translational Science Alliance Seed Grant, Emory University’s Primary Care Consortium, and discretionary research funds allocated by Linda McCauley, dean of Nell Hodgson Woodruff School of Nursing, Emory University. The team began with five students for the 2017-18 school year and now comprises about 30 students from Emory University, Georgia State University, Mercer University, and Philadelphia College of Osteopathic Medicine. Students’ professional career goals include law, medicine, nursing, pharmacy, public health, and social work.
Why was I intrigued by Atlanta’s hotspotting project? My first view of healthcare was via the lens of addressing social determinants of health. Through Health Leads, a national nonprofit organization, I volunteered at a federally qualified health center in South Chicago, where I worked with patients on arranging transportation to and from appointments, securing reliable sources of food, and acquiring winter clothing. I witnessed the substantial return on investment that results when people are provided basic necessities for healthy living. Based on that experience, when I began my studies in nursing school, I hoped to learn more about how to address social needs as a healthcare provider. So when the opportunity came to help establish Atlanta’s hotspotting team, I was eager to dive in.
How do student hotspotters work with Atlanta’s highest utilizers? The team is connected to Grady Hospital’s Chronic Care Clinic (CCC). Established in 2017, the CCC siphons frequent users of the hospital’s emergency services (defined as at least six emergency department visits in six months) into outpatient management when they present without emergent concerns. The team assigned to work with these high utilizers includes registered nurses, advanced practice providers, pharmacists, community health workers, and paramedics. An important asset of the Chronic Care Clinic is its ability to refer clients to Grady’s Mobile Integrated Health Program, which utilizes a nurse practitioner and paramedic to conduct extended home visits with patients where they address both medical and social concerns.
After one year, the first cohort of Chronic Care Clinic healthcare providers witnessed from enrolled patients a 65 percent reduction in emergency department visits, a 17 percent reduction in admissions, 146 percent reduction in outpatient visits, and a 50 percent savings in monthly costs. Following this success, the CCC is expanding to include student hotspotters, who, working with high utilizers, will further enable outpatient management of patients with complex chronic conditions through improved navigation, education, and access to resources.
As with previous models that have proven successful in engaging high utilizers, Atlanta’s newest hotspotting team is interprofessional. The 2018-19 cohort includes students—together with faculty advisers—who are pursuing careers in law, medicine, nursing, pharmacy, public health, and social work. In addition to the variety of work experiences they bring to the task, their present education levels are also varied, ranging from recently enrolled to nearing graduation.
A common theme in student hotspotter applications is a desire to obtain hands-on experience working with patients and interprofessional teams. While students acquire a tremendous amount of knowledge during formal training for a chosen profession, they yearn for opportunities to form long-term relationships with patients where they have responsibility for certain components of patients’ care. Because they can feel “siloed” by the confines of their own programs, students interested in hotspotting also express interest in forming partnerships with peers in other professions.
Although my reasons for choosing nursing as a profession were similar to those of my peers who chose to pursue a career in healthcare—including interest in life sciences, desire to work in a hands-on field, and goal of helping people be happy and healthy—I can count on two hands the number of times I have trekked across campus to visit Emory University School of Medicine. But when I graduate and begin my career as a family nurse practitioner, it is inevitable that I will work with specialists from a variety of professions. Why not cross the bridge earlier?
Different strengths, same goals
In working with student hotspotters who represent a variety of disciplines, I am excited to discover the strengths that various disciplines bring to addressing the same goals. Besides benefiting personally from interacting with students of diverse disciplines, I am pleased by what that diversity offers patients. Law students are best prepared to assist in parsing details of disability paperwork and insurance eligibility. Pharmacy students are best prepared to help establish daily routines for medication adherence. Public health students are best prepared to offer personalized education within systemic parameters. Medical and nursing students are best prepared for debriefing after medical appointments and for navigating the healthcare landscape. Finally, students preparing for careers in social work are best equipped to elicit patient goals and access community resources for achieving them.
As a soon-to-be family nurse practitioner, I hope to keep lessons I’ve learned from interacting with my multidisciplinary hotspotting peers in my back pocket for application in future cases that require more than what I learned in the classroom. I say that not to express disappointment with my nursing education, but rather to recognize the many venues by which I can garner solutions that help me help others live happy and healthy lives in an affirming and sustainable manner.
Questions about whether or not I chose the optimal career path may always be latent in the back of my mind, but helping form Atlanta’s Interprofessional Student Hotspotting Learning Collaborative has given me the opportunity to learn from peers of many disciplines and opened my eyes to the unique perspectives that nurses bring to interdisciplinary teams. I am excited to see what the 2018-19 team of student hotspotters can offer Grady’s high utilizers. RNL
Colin McNamara, BSN, RN, a Rising Star of Research and Scholarship, is working toward his Master of Science in Nursing degree and family nurse practitioner certification at Nell Hodgson Woodruff School of Nursing, Emory University, in Atlanta, Georgia, USA.
Colin McNamara will present “Student Hotspotting: An Opportunity for Student Nurses to Work With High Utilizers on Interprofessional Teams” on Monday, 17 September 2018, at Sigma’s Leadership Connection in Indianapolis, Indiana, USA.