Inevitably, electronic systems will replace paper-and-pen reporting and recordkeeping. Here hospitalists can take the lead, too. Unlike physicians who admit patients to multiple hospitals (each with a different information system), hospitalists practice in a single institution with only one system to learn. Hospitalists’ patient load may also help them to master new technology more quickly.
Surveys show that, while many hospitals have electronic ordering systems in place, relatively few physicians actually use them. In many cases, nurses or pharmacists place the electronic orders. Hospitalists who place their own orders can contribute to a reduction in medication errors by eliminating the pass-through of information that often causes misunderstandings.
Patient-Centric Healthcare: the New Paradigm
The traditional hospital system—and the healthcare system as a whole—are provider-oriented and provider-directed. Many patients, especially older ones, have a “doctor knows all” mindset, and they typically ask few questions—even when they don’t understand their treatment plans or exactly how they’re to take their medications when they go home. Case in point: A patient who was discharged from the hospital died at home shortly thereafter. The cause: His wife misunderstood the instructions for his pain medication and mistakenly applied six transdermal patches to his skin at one time instead of the single patch she should have applied. The multiple patches delivered a fatal overdose of the narcotic fentanyl.
Many experts believe that better informed—and empowered—patients are the key to reducing the number of sentinel events, including ADEs. The IOM report advocates a shift from a provider-centered to a patient-centered healthcare model. In this new paradigm, hospitalists would be much more expansive in their communications with patients. With regard to medications in particular, the report recommends that a physician:
- Review the patient’s medication list routinely and during care transitions.
- Review different treatment options.
- Review the names and purposes of all medications.
- Discuss when and how to take the medication.
- Discuss important and likely side effects and what to do about them.
- Discuss drug-drug, drug-food, and drug-disease interactions.
- Review the patient’s (or surrogate’s) role in appropriate medication use.
- Review the role of medications in the overall context of the patient’s health.
There are barriers to surmount before patients can become full partners in their healthcare. One of the most obvious is that patients need to be much better informed, and—when they are incapable of making appropriate decisions—they need surrogates to stand in for them. Patients need access to trustworthy and understandable information both online and in printed materials.
The IOM report recommends a government-sponsored national drug-information hotline; medication leaflets that provide standardized language in a manner that is appropriate for various age, literacy, and visual acuity levels; and development of personal health records.
PeaceHealth in Washington state took up the challenge of developing personal health records in 2001. PeaceHealth’s Project Manager, Mary Minniti, invited patients to design the system for self-management and communication among care team members. Today, the Shared Care Plan Personal Health Record is a reality, and Marc Pierson, MD, who is PeaceHealth’s regional vice president of Clinical Information and Special Projects, says “early evidence suggests that this type of tool promotes personal responsibility and positively affects patients’ confidence and active participation in their care.”
The tool is available on CD from www.peacehealth.org for those who would like to adopt it for their use.
Final Thought
The bad news is that sentinel events still take a staggering human and economic toll. The good news is that momentum is building for an important change in the way healthcare is delivered. Better communication, new technologies, and, perhaps most importantly, true provider-patient partnerships hold the promise of making hospital healthcare much safer. Hospitalists play a key role in this new scenario. TH