But like the optimistic person I am, I immediately saw a burning platform for change and began to plan our attack on this problem.
What is our chief tactic? A good discharge. I am convinced more than ever that we simply need to focus on a better discharge.
I am not alone in this thinking. Almost from the beginning of the hospitalist movement, we have focused on the “black hole,” that period of time from discharge to first followup appointment. Many of you who have come to SHM meetings have attended discharge planning and transitions of care sessions. We have worked closely with the Hartford Foundation in developing a good discharge for elderly patients. Part of this effort resulted in discharge checklist you will find on the SHM Web site (www.hospitalmedicine.org). The next version of this is Project BOOST (Better Outcomes for Older Adults through Safe Transitions), led by Mark V. Williams, MD, principal investigator on the project and professor and chief of the Division of Hospital Medicine at the Feinberg School of Medicine at Northwestern University in Chicago.
In early June, a group of SHM leaders visited with MedPac, which advises Congress on Medicare policy. MedPac is interested in recommendations to improve the readmission rates in the U.S. If the plea to simply provide good medical care doesn’t move you, I hope the CMS “incentives” will.
What You Can Do
Focus on the good discharge. Many tactics are intuitive. Ensure that a succinct yet complete discharge summary is sent to the next physician in a timely manner. Clearly articulate a treatment plan not only immediately after discharge but for the next several months in general. Be sure to list all test results, their interpretation, and any pending at the time of discharge. Reconcile all medications from the admission list. Teach patients and families about the illness and what to do in certain circumstances.
These are just a few of the things to do. I am sure we will discover more or refine those we know. But by simply focusing on a good discharge, your program and hospital will be in good shape for the coming scrutiny. TH
Dr. Cawley is president of SHM.