Step-by-Step Medicine

The policy statement emerged from a multi-stakeholder consensus conference convened by SHM, the American College of Physicians (ACP), and the Society of General Internal Medicine, which was attended by more than 30 medical specialty societies, governmental agencies, and performance measure developers. Participants focused on what standard pieces of information should be exchanged among providers during inpatient to outpatient transitions, and they issued a set of standards for improving those transitions (see “Managing Transitions in Care Between the Inpatient and Outpatient Settings,” p. 7).

“This consensus statement has enormous significance,” Dr. Ford says. “We’re finally shedding light on how to tackle patient handoff and hospital readmission issues, and we as a specialty have to take on care-transition improvement as our mantra. If we were to solve just that one piece, we can more easily start implementing other clinical guidelines. Care-transition guidelines are a fundamental tool to build consensus within your own group and with other clinicians in a team approach.”

Dr. Corrigan applauds the physician groups for publishing the transitions-of-care statement and encourages the societies to work together to “take it to the next step, which is to develop the measures and get them endorsed through the NQF process.”

SHM members are participating in workgroups convened by the NQF to identify standardized performance measures and to develop action plans over the next few months for several national priority areas—one of which is care coordination. “We have a ways to go to achieve better patient handoffs and information exchange between hospitals and other settings in the community. Hospitalists can drive the development of those guidelines and protocols,” Dr. Corrigan says. TH

Christopher Guadagnino, PhD, is a freelance medical writer based in Pennsylvania.

References

1. Kripalani S, LeFevre F, Phillips CO, Williams MV; Basaviah P, Baker DW. Deficits in communication and information transfer between hospital-based and primary care physicians: implications for patient safety and continuity of care. JAMA. 2007;297:831-841.
2. Timmermans S, Mauck A. The promises and pitfalls of evidence-based medicine. Health Affairs. 2005; 24(1):18-28.
3. Snow V, Beck D, Budnitz T, et al. Transitions of care consensus policy statement: American College of Physicians, Society of General Internal Medicine, Society of Hospital Medicine, American Geriatrics Society, American College of Emergency Physicians, Society of Academic Emergency Medicine. J Hosp Med. 2009: 4(6)364-370.

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Managing Transitions of Care Between the Inpatient and Outpatient Settings

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The following are joint recommendations from SHM, ACP, SGIM, AGS, ACEP, and SAEM, based upon a multi-stakeholder consensus conference in July 2007 and published in the July/August Journal of Hospital Medicine (http://onlinelibrary.wiley.com/doi/10.1002/jhm.510/full):

1. Communication and information exchange between the sending and receiving provider should be timely, as dictated by clinical presentation and urgency of follow-up care required.
2. The transition record should always include at least these data elements: principal diagnosis, medication list, contact information of the transferring physician, patient’s cognitive status, test results or pending results. An ideal transition record would add six more elements.
3. All communications need to be secure, private, HIPAA-compliant, and accessible to patients and their providers.
4. Communities need to develop standard data transfer forms, with the ability to modify information as a patient’s condition changes.
5. The sending provider maintains responsibility for the care of the patient until the receiving provider confirms that the transfer is complete. The sending provider should be available to clarify issues of care, and the patient should be able to identify the responsible provider.
6. Information transfer should be timely, as determined by transition setting, patient circumstances, level of acuity, and clear transition responsibility.
7. Medical institutions must adopt national standards and establish processes to promote effective transitions of care.
8. Standardized and evidence-based metrics related to these standards should be used for monitoring and improving transitions.