An integrated informatics system that prompts hospitalists and primary care physicians when patients do not arrive at expected follow-up or when test results return after discharge would be optimal. But a simple phone call to identify problems can be effective. Some hospitalist groups have incorporated routine post-discharge telephone contact into their practice—but most have not. Research identifying which patients would benefit is needed to allow targeted use of resources.7
While it’s understood that not all patient discharges will go smoothly, just as not all battleships will arrive at port without incident, there is frequently an opportunity to recover when things begin to go awry. A change in the common attitude that hospitalist responsibility ends when the patient leaves the hospital is necessary.
An element of the solution lies in the creation of feedback loops to identify patients who are not obtaining follow-up as expected. This step requires a commitment of resources—something our fragmented medical system, with location-based reimbursement, does not provide incentives for.
Creation of a feedback loop may be as complex as integrated medical informatics systems, or as simple as a follow-up phone call, but it is incumbent on each hospitalist to examine the environment in which they practice and ensure this vital element of a safe and reliable system is being addressed. TH
Drs. Cumbler and Egan are assistant professors in the Section of Hospital Medicine at the University of Colorado at Denver.
References
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- Dudas V, Bookwalter T, Kerr KM, Pantilat SZ. The impact of follow-up telephone calls to patients after hospitalization. Am J Med. 2001;111:26S-30S.
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- Mistiaen P, Poot E. Telephone follow-up, initiated by a hospital-based health professional, for postdischarge problems in patients discharged from hospital to home. Cochrane Database of Systemic Reviews 2006; 4. Article No.:CD004510. DOI:10.1002/14651858.CD004510.pub3.