Paul Swanson, newly appointed Director of Emergency & Hospital Services, is excited about the new “Hospitalist” program that Eastern Plumas Health Care has just initiated on their Portola campus. EPHC’s program is a variation of one that is being utilized increasingly nationwide. Under the new system, emergency room physicians will admit ER patients needing hospitalization and continue to care for them during their hospital stay. Swanson said that Chief Executive Officer, Tom Hayes, promoted the change because he felt it would improve continuity of care.

According to Swanson, ER doctors at the hospital have already been evaluating patients and writing admitting orders for several years, so the transition to caring for them in the acute hospital setting is a smooth one. It works easily in a small, rural hospital like EPHC, where volumes are low enough that ER doctors have the time to care for patients in both arenas.

Swanson is enthusiastic about the doctors he works with in the ER. There are seven ER physicians in all, two of them full time—himself and Dr. Susan Marron. The others come up from the Bay Area and other urban areas, where they work in busy emergency rooms in large hospitals. This, said Swanson, gives them the ER experience they need to be top quality physicians. He said the hospital’s ER physicians are all “excellent clinically, very conscientious, and very experienced doctors [who are] committed to this hospital and excited about this expansion of their area of practice.” Swanson, who also worked in the Bay Area before moving here full time, said EPHC is a “unique place. I’m happy to come here, happy with the staff, and pleased with the community.”

He’s very positive about helming this new program and is enjoying his ability to have a “wonderful, different relationship with patients, bonding with them more.” Because the ER is just down the hall from the acute wing, he’s able to make rounds on patients that he has admitted to the hospital several times a day.

In many cases, care is better here, he added, because the small hospital and slower pace allows him to take the time a patient needs. If, for example, a patient has a secondary problem they are concerned about, he said, they’d never be allowed to broach it at a large city hospital. Here, it’s a matter of caring for the whole patient.

Further, ER doctors are more familiar with “what critically ill patients look like,” said Swanson. For instance, they know what “congestive heart failure looks like in its serious states.” He believes the ER doctors’ experience with critical patients will aid them in giving acute care patients they admit to the hospital the best care possible. “We’re familiar [with critical illnesses] on a gut level, like a mechanic knows his tools, we know how to deal with that.”

As a side note, it allows primary care physicians to focus on their work with clinic patients. Previously, on call clinic doctors could be awakened in the middle of the night to see a patient who had just been admitted to the hospital. Then, they’d have to grab a few hours of sleep and see a full schedule of patients in the clinic the next day. In addition, they would have to take time out to go over to the hospital to check on these patients during their clinic day.

EPHC just started moving to the Hospitalist model at the beginning of the year, with Swanson taking over as Director at that time. Explaining how he stepped into this role he said, “I was quite enthusiastic about the new model, and I have the time and the energy . . . to get this program started. It’s been fun,” he added.

Swanson was born and raised near St. Paul, MN, “a good place to grow up,” he said. “Solid, old fashioned values were still in tact.” In the suburbs of St. Paul where he lived, it was wooded, and he’s always enjoyed the forest and outdoor activities. He received his undergraduate degree from Harvard University and returned to his home state to attend the University of Minnesota Medical School. He did his residency in ER at Bowman Gray Medical Center in North Carolina. After that, he returned to MN for one year.

And then he visited San Francisco, said Swanson, emphasizing the significance of that trip. He loved California and moved here, working in emergency rooms in Los Angeles (at White Memorial in East L.A.) and San Francisco. Chinese Hospital, located in China Town, San Francisco, was “fascinating,” he said, because patients were “mostly elderly Chinese who spoke no English.”

While there, he met Frank Long, then Director of EPHC’s Emergency Room. Long told Swanson about the hospital here, and Swanson started the San Francisco to Plumas County stint in June 2002.

Since 2005, Swanson has been working in EPHC’s Emergency Department full time. He likes the atmosphere in a small community, he said. “After 10 years, I know many patients well.” And, he’s enthusiastic about changes he’s seen in the hospital in the last few years. “There’s been a big change in the hospital since Tom [Hayes, CEO] came on board. The culture and atmosphere internally and externally has seen a huge positive change,” said Swanson. “With the addition of Hayes, Teresa Whitfield (Director of Quality and Operations), and Mark Schweyer (Director of Nursing) there’s a constant improvement of policies and procedures. Everyone in the hospital is very happy about the improvements. In many respects it’s a very different hospital than it was two years ago, and that process is ongoing. It’s hugely positive. The community needs to understand that. It’s still the same building, but a lot has changed.”