Accreditation

Tip of the Week: Communication is the single most important component of a successful hospitalist program.

Accreditation Connection, June 6, 2005

1. Establish a process for requesting hospitalist services

Discussion between hospitalists and other physicians is arguably the most important communication link in a hospitalist program. Therefore, hospital policy should clearly define how other physicians, physician office staffs, or emergency room physicians might access this service.

Some of the most commonly employed mechanisms through which physicians contact hospitalists include the following:

 The referring physician or office staff pages the hospitalist to inform him or her of the requested admission or consultation.
 The referring physicians or office staff calls in their request to the hospitalist's office or an admissions coordinator.
 Emergency rooms directly notify the on-call hospitalist via pager or telephone.
 Urgent or emergency requests require direct communication between the referring physician or designee and hospitalist.

2. Communication with referring physicians

If a hospitalist needs patient information from a referring physician's office, there should be a process for requesting this information. Such a mechanism might include a formal method for requesting documents and a checklist of the types of information needed. Typical office information requests include a recent medical history and physical exam, a current list of medications and allergies, and recent lab tests or x-ray reports.

Not all primary care physicians will want to see all the details of a patient's hospital visit. Knowing their preferences is important in constructing this part of a hospitalist program's communication process.

Most primary-care physicians will want to be alerted when there is

 a significant or unexpected clinical deterioration
 a change in code status
 a conflict between caregivers and patients or family

3. Post-discharge communication

In arriving at a procedure for post-discharge communication, it is again important to know what medical staff members want. The following is the discharge information needs primary-care physicians commonly identify:

 Primary-care physicians need to know when their patient is being discharged, as well as what happened during the hospitalization.
 Most hospitals have discharge summaries dictated and faxed or mailed to the primary-care physician's office. Ideally, this information should be turned around in short order so the primary-care physician receives it the same day as the discharge. Any discharge summary should include a list of a patient's diagnoses, medications, key diagnostic tests, and/or any other data the primary-care physician desires.
 Patients often have difficulty with discharge instructions and plans. Informing the primary-care physician verbally and noting in the discharge summary any key follow-up issues helps to optimize patient follow-up and compliance.
 It's helpful for hospitalists to make a single, daily telephone call to primary-care physicians for updates and discharges.
 Provide each patient with a copy of his or her own discharge summary, as he or she is apt to bring it along to follow-up appointments.

4. Communication with patients during hospitalization

Many patients and families have never been exposed to hospitalists before, and therefore may not understand how these professionals function. Organizations may require all hospitalists, upon introducing themselves to a patient, to give a brief, standard description of the hospitalist service. This description should be defined by each group of hospitalists and standardized so patients and families receive the same information.

Most patients also appreciate regular feedback regarding their progress. It is important that hospitalists explain to patients what is planned for them and what they might expect. It is particularly important to inform them of when they can expect to be discharged.

In addition to setting realistic expectations, hospitalists should have a standard process that allows patients and families to get a hold of them. This process might include rounding at the bedside at an agreed-upon time, having the nursing staff page the hospitalist when family is available, or some other defined mechanism.

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