Over at Med Rants DB cited an article in Annals of Internal Medicine lamenting the discontinuity of care associated with the hospitalist movement. Earlier today I pointed out that hospitalists, rather than being the integrators of health care some purport them to be, have in many ways become the enablers of fragmented care.
So now that we have built discontinuity into the system how can we mitigate the effects? This is a good opportunity to point out, again, that there are now guidelines for communication between hospitalists and primary physicians. These guidelines do not put the onus for communication on the hospitalist. It's a two way street, a push-pull function. According to the guidelines emergency room physicians should call the PCP and discuss the case before handing the patient off to the hospitalist for admission. The PCP is expected to contact the hospitalist and provide input, as well as visit the patient in the hospital. These guidelines are not well publicized. They were not promulgated or promoted by the Society of Hospital Medicine. They could go a long way toward closing the communication gap, but I suspect adherence is very low.