He suggests a more restrained, collaborative approach.
“A policy of the patient or family always having the ‘right’ to a face-to-face physician evaluation would do much more for patient care,” says Dr. Rudolph. “A family or patient demanding urgent evaluation is often appropriately concerned, anxious, or angry. This is an excellent time for the physician to review the case to make sure all is being done appropriately and to address the patient and family’s medical and emotional needs.”
Dr. Rudolph also says allowing patients and families to call a code “will frequently result in the staff feeling that the patient cried wolf, which will invalidate the patient’s and family’s concerns.” He asserts that while patient and family involvement in care “is critical to the healing process … the physician has to set limits on how much of the care the patient and family can dictate.”
A hospitalist working in a hospital with a policy like UPMC’s “would lose significant ability to prioritize his/her work,” Dr. Rudolph continues. “There are so many unplanned interruptions that a hospitalist needs to learn to deal with on a routine basis that increasing the number of interruptions where dropping everything is necessary would lead to a sense of loss of control and an increased burn-out rate.”
He says it would also force hospitalists to second-guess their colleagues, “which will adversely affect team medicine in rapid fashion and may further increase wasteful, defensive medicine practices.”
But Joseph Li, MD, director of the hospital medicine program at Beth Israel Deaconess Medical Center in Boston and a member of SHM’s board of directors, counters that patient-activated RRTs are a useful part of a team approach to care.
“I’m a strong believer in terms of ‘the patient knows best’,” says Dr. Li. “Ultimately, it’s a very good thing to allow patients to participate in their care. I would say the potential advantages (of a Condition H RRT policy) far outweigh any drawbacks.”
Dr. Li sees a potential upside not only for patients and their families, but for hospitalists.
“More than anybody, hospitalists oftentimes are leaders in rapid response teams, and if the policy becomes widespread, hospitals would require more resources for the hospitalist,” he says. That, he says, could lead to hiring more hospitalists.
There are those who theorize that while a Condition H policy might benefit patients, it may also be another source of confusion for families. These critics fear alienating some who believe it is the hospital’s job to be sure their family member is doing well, not theirs.
Dr. Li strongly disagrees. “We have a situation in this country where often the patient’s voice is not heard,” he says. “Anytime we can improve the opportunity for a patient to be heard, that’s good for the patient and good for our healthcare system.
Martin puts it another way.
“It’s the right thing to do,” she asserts. “Think about it: relatives and friends call 911 from home or wherever when there‘s an emergency. Condition H is similar to that. Why wouldn’t we let patients and family do that in the hospital?” TH
Tom Giordano is a journalist based in Connecticut.