Better care and lower costs for vertigo patients

Photo illustration of a dizzy man with his hands on his head.

“Turn the head back and forth slowly twice,” explained Kelley Clark, DPT, Salem Health physical therapist, to a young doctor while holding his head carefully. “Then a quick flick of the wrist…”

Listening in, you might think this was a martial arts course. Instead, Salem Health rehabilitation staff met with a roomful of ER doctors to fight a common yet often misunderstood type of vertigo called benign paroxysmal positional vertigo. Kelley taught her colleagues a couple simple ways to diagnose and treat BPPV.

Studies show 2.4% of the general population experience this type of vertigo at some point. It can cause strong, sudden feelings of dizziness and people may suffer for weeks, needing to visit the doctor many times and stay home from work as a result. Meanwhile, using these methods, a doctor can sometimes diagnose and take care of BPPV in just minutes.

Salem Health staff saw an opportunity.

“Our big concern was that we were not treating this type of vertigo in the best way we could,” Joshua Walterscheid, MD, medical director for Salem Emergency Physicians Service explained. “We believed by adopting some proven formulas and educating physicians, we could decrease lab and imaging tests while improving care of patients with this vertigo.”

Coordination is key

According to the American Physical Therapy Association, more and more physical therapists are asked to assist with patients in the emergency department, to help ensure appropriate care. Three years ago, Salem Health began working to get ahead of the curve.

In 2016, Salem Health Foundation sponsored two staff members to get certified through a program at Emory University for this work. The physical rehabilitation center and emergency department education session was the second of its kind.

“Increasing the number of staff that are comfortable assisting with the diagnosis and treatment is the aim,” said Melissa Berry, manager of Salem Health acute rehabilitation services. “Supporting emergency doctors is an important part of our continuum of care.”

Besides training them, the hospital created an application that pops up on computers to help doctors. It guides them through a step-by-step process to define the diagnosis.

“We are improving patient health and getting rid of unnecessary tests at the same time,” said Dr. Walterscheid. “Thanks to the support from our colleagues, only 33% of patients who come in with this type of vertigo are sent for imaging tests now compared to 77% before.”

While these improvements are encouraging, Salem Health hopes to go further. Salem Health physical rehabilitation and emergency department colleagues meet every three months to continue finding better ways to work.

As a result of the partnership, patients receive fewer tests and go home sooner with better health results — a win for both the patient and hospital.