Corrective action: Holding multidisciplinary patient-care rounds in which the social worker and other providers (nurses, pharmacists, case managers, etc.) actively participate can have a positive impact on communication and collaboration, Dr. Simone says. In addition to reviewing the treatment approach and clinical response, teams can discuss discharge planning, insurance coverage, and patient adherence.
“These rounds must be well organized, so they do not become time consuming and decrease the efficiency of all involved,” Dr. Simone says, adding some HM groups impose a time limit of two minutes per patient or discuss only the most acute patients or those approaching discharge.
If interdisciplinary rounds aren’t possible, hospitalists can work with other providers to develop content expectations that should be entered in the patient’s chart daily or as appropriate, Dr, Simone says. Each provider would then be required to read the daily entry in the patient’s progress note.
“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,” Dr. Pyke says. “The progress record is probably the most consistent way to do that.”
Many electronic health record (EHR) systems don’t provide as much detail as traditional written records, Dr. Pyke says. He advises hospitalists teams use an EHR that, in addition to providing templated information, can transcribe doctors’ dictated notes in real time.
Proven Methods
Scenario: An expensive, broad-spectrum antibiotic is administered to a patient in the ED because doctors haven’t identified the offending organism. Once stabilized, the patient is transferred to the medical floor. Rather than switching to a less expensive, equally effective medication when the culture results come back, the hospitalist continues ordering the expensive drug.
Corrective action: HM teams can develop treatment approaches to common medical conditions based on data in the literature that defines best practices, Dr. Simone says. These evidence-based clinical order sets can be pre-printed so that each hospitalist can approach the same diagnostic workup and treatment in a standardized manner.
“It encourages physicians to utilize proven methods,” he says.
Dr. Pyke recommends hospitalists input medication orders in the computer system. Physician order entry forces the hospitalist to look at the patient record, which makes it more likely they order the appropriate intervention, he says.
“Because the physician is going off of solid information about that particular patient, there’s less chance of a mistake happening or something getting overlooked,” Dr. Pyke says.
Lisa Ryan is a freelance writer in New Jersey.