Monday, February 22, 2010

Guidelines and principles for interaction with hospitalists

Although this was released by AAFP for its members it has the imprimatur of AAFP as a guideline document and so would apply to all specialties who participate in the hospitalist model.

I thought this was of interest:

If patients present to the emergency department (ED) and the ED physician assesses them, the ED physician should then contact the patient's family physician to determine if admission is necessary or if close follow up or outpatient work up is more appropriate.

If admission is necessary, the family physician should communicate information on pre-hospital treatment, work up, co-morbidities and ongoing specialty consultations, along with family and social concerns, advanced directives, etc., to the inpatient care physician who is assuming management of the patient's care.

In other words not just the hospitalist but also other providers bear some responsibility in the transfer of information.

And this says a lot:

The inpatient care physician should be readily available to discuss the patient's medical problems and hospital course with the family and should provide timely updates to the family physician designated by the patient. Communication with the family physician is extremely important at the time of any changes in the patient's status, complications or new diagnoses (e.g. cancer).

The inpatient care physician should communicate the treatment plan and follow up recommendations to the patient's family physician or the covering physician on the day of discharge. This may be best accomplished by having the discharge summary dictated and faxed to the family physician.

When family physicians refer their hospitalized patients to the care of an inpatient physician, the AAFP strongly encourages them to maintain ongoing communication with the patients, their families, and the inpatient care physician throughout the hospitalization.

So communication between hospitalist and PCP is a two way street, a push-pull mechanism. And, according to this guideline, the responsibility for patient satisfaction rests in part with the PCP. When PCPs maintain communication with hospitalized patients and their families it builds confidence and defuses a lot of issues.

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