Beyond Liability Protection
Adhering to the “higher standard” of patient safety can improve transitions of care even further, Dr. Greenwald believes. Such actions might include a mechanism for patients to reach a member of the hospitalist team (nurse, pharmacist or physician) if they have post-discharge concerns; empowering patients and family members to know what to do if an adverse event occurs; and enabling patients to have copies of their own medical information (discharge summary, lab tests, medication reconciliations).
“In addition, we need to involve the nonmedical caregivers who are going to help the patient recuperate,” he asserts. Physicians can educate patients and their caregivers about what happened while they were in the hospital, what treatments are planned, and what information is pending at discharge. While these efforts might require that hospitalists shift their thinking about doctor-patient roles, they can help to create a more comprehensive approach to patient care.
Inherent Dangers
Ironically, what hospitalists do best—promote effective inpatient management—can also lead to a disconnect when the patient leaves the hospital. “Part of what we do, as hospitalists, is to drive down the patient’s length of stay and get them home sooner,” Dr. Grace says. “While unquestionably beneficial for a variety of reasons, it increases the chance that a patient can leave before a result comes back.”
“This change from the continuity of healthcare [provided by a physician who also saw his or her hospitalized patients] to a division of labor does have some inherent fragmentation,” agrees Dr. Wright. “We need to still look at the patient as a whole and be in communication with [our primary care colleagues] and supporting each other on both ends so that the patient does get this more comprehensive care.” TH
Gretchen Henkel is a medical writer based in California.