Postdischarge care coordination has been a major challenge. Approximately one-third of patients are discharged to nursing homes. Most of the others are affiliated with primary care physicians located in other communities who are not members of the Milford Hospital medical staff. Communication with these physicians has been improved by an electronic record management system that allows automated fax transmission of discharge summaries. Limited outpatient services are available for Medicaid patients and for those without insurance. The hospital medicine service does not provide outpatient care.
Another challenge involves care for critically ill patients. Although there are several physicians with training in pulmonary disease on the private staff, the hospital had not developed effective critical-care services. There are 2 hospitalists with critical-care training, and we have been working with the other staffers to improve their competence in critical care. The hospitalists provide 24-hour response to unstable patients throughout the hospital and have dramatically reduced unexpected mortality.
Future development will focus on improving hospitalist productivity with information technology. The hospital has undertaken installation of an integrated clinical-information system, which will include direct physician order entry and deployment of wireless technology. It is expected that many of the difficulties experienced by other hospitals with physician order entry will be ameliorated by hospitalist involvement, as the staff is comfortable with computer use. We also expect that the hospitalists will develop leadership roles within the medical staff and develop skills in quality improvement.