It demonstrates to the patient that the HM team is in sync and avoids patient confusion. It also gives the hospitalist and team members an opportunity to discuss the change and the reasoning behind it, Cardin says.
“I think it’s important for hospitalists to stop and understand where other providers are coming from before they try to make themselves understood,” she says. “Once they understand why someone is proposing to manage a patient a certain way, it may help them communicate their plan and what they want to do differently.”
By first seeking to understand, Cardin says, a hospitalist might also realize that their plan isn’t the best option, or that a better plan can be developed through compromise.
“There have been times where I’ve had a particular treatment modality that I believed was correct and a non-physician provider recommended another, and I leaned toward what they recommended because they presented a solid case for it,” says O’Neil Pyke, MD, SFHM, chief medical officer for Medicus Healthcare Solutions, a healthcare consulting and staffing company based in Salem, N.H. “Similarly, there have been times where they’ve explained their treatment plan and I’ve said no.”
The key is listening before making a final decision, he notes.
Standardize Handoffs
Scenario: A hospitalist signing out fails to communicate a patient’s end-of-life wishes to the hospitalist assuming care. The patient has a DNR, however, when the patient stops breathing, a Code Blue is called and the patient is revived.
Corrective action: It’s essential for hospitalist teams to adopt a standard process for handing off patients to new providers during shift changes, says Peter Thompson, MD, chief of clinical operations for Apogee Physicians, a physician-owned and operated hospitalist group based in Phoenix.
Mandatory off-service notes that follow a set template are one simple approach, says Kenneth G. Simone, DO, SFHM, president of Hospitalist and Practice Solutions, a hospitalist practice management consultation company based in Veazie, Maine. The off-service notes can include a patient’s SOAP (subject, objective, assessment, and plan) note, as well as address code status, current medication list, primary-care physician, and family contact name and number.
“This simple tool dramatically reduces miscommunication and errors that occur during care transitions,” Dr. Simone says. “I implemented this approach when I was directing a hospitalist program and it worked remarkably well.”
Experts agree handoffs always work best when providers can communicate face-to-face. The incoming provider can get a better feel of what’s happening with the patient; the outgoing provider can make sure that the information conveyed is understood, says Christina Lackner, PA-C, lead physician assistant for the Collaborative Inpatient Medical Service (CIMS) at Johns Hopkins Bayview Medical Center in Baltimore.
Regardless of how the handoffs are conducted, Lackner says they should be as detailed as possible.
“Physicians that I’ve gotten the best sign out from are the ones who clearly convey what they want, state specifically what they did and what they’re looking for, and give me a little background on the patient,” she says. “Also, to double check that I’m comprehending the information, they ask me questions to make sure I’m giving them the right answers.”
As the head of the interdisciplinary team, hospitalists have to make sure what they are trying to do gets dispersed to all the members of the team.
—O’Neil Pyke, MD, SFHM, chief medical officer, Medicus Healthcare Solutions, Salem, N.H.
Organized Rounds
Scenario: A hospitalist neglects to inform the social worker that a stroke patient is resistant to outpatient physical therapy because he can’t afford the care and lacks a means of transportation to the facility. The social worker spends considerable time arranging for the physical therapy. After being discharged from the hospital, the patient doesn’t adhere to the therapy regimen.