These solutions get information to the point of decision when the patient is there and the acute need must be met. For those in the trenches this is good news—a great improvement on the hunt-and-peck paradigm.
In a broader strategic approach, SHM has advocated giving hospitalists a role in defining the standards and measures to be used in assessing performance in transitions of care. In July, SHM worked with the ABIM, the American College of Physicians, the Society of General Internal Medicine, the American Geriatrics Society, and the Agency for Healthcare Research and Quality to develop consensus on transitions-of-care standards. This group included most of the big players in the house of internal medicine as well as representatives from nursing, pharmacy, case management, home health, patients, and families. The American College of Emergency Physicians (ACEP) joined the discourse in August.
At the same time, SHM has been working with the American Medical Association’s Physician Consortium and the National Quality Forum to use standards conceived in consensus to develop measures for transitions of care. The measures would mark either stand-alone performance or performance with specific disease states (e.g., management of diabetes or acute heart failure).
Hospitalists will need resources and tools to give patients the best care and smoothest transitions (and score well on these measures). SHM has developed a Web-based quality-improvement resource room on transitions and continues to work with a broad coalition to improve the discharge process under our Hartford grant.
We add real value for our patients. But our job doesn’t end at the hospital door. Hospitalists recognize their obligation to patients as well those who will assume their care outside the hospital. Whether working on tools with Intel or RevolutionHealth or working with professional societies and organizations charged with developing performance standards and measures, hospitalists and SHM must take an active leadership role.
This is not easy stuff and can’t be solved in one meeting—or even one year.
A few years ago no one was talking much about patient safety, notes past SHM President Bob Wachter, MD, professor of medicine at the University of California, San Francisco, associate chairman of UCSF’s Department of Medicine, and chief of the Medical Service at UCSF Medical Center. That is, until the Institute of Medicine’s 2000 report “To Err Is Human: Building a Safer Health System” and some disastrous medical errors.
Transitions aren’t happening well, and care is sporadic and isolated. This is high on our agenda; SHM and hospitalists are willing to work with any group that will help all of us get closer to a solution. TH
Dr. Wellikson is the CEO of SHM.