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The Patient Handoff: Communication between Primary Physicians and Hospitalists

The Patient Handoff: Communication between Primary Physicians and Hospitalists. Julia S. Wright, M.D. July 11, 2007. Primary Care-Hospitalist Patient Sharing. Division of Labor Quality of care Medicolegal Physician Interaction Continuity

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The Patient Handoff: Communication between Primary Physicians and Hospitalists

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  1. The Patient Handoff: Communication between Primary Physicians and Hospitalists Julia S. Wright, M.D. July 11, 2007

  2. Primary Care-Hospitalist Patient Sharing Division of Labor • Quality of care • Medicolegal • Physician Interaction • Continuity Handoff: transfer of patient care responsibility from outpatient to inpatient MD. Note: Intervention Independent

  3. Goals of Handoff • Effective information transfer • Communication system providing timely, accurate, thorough information

  4. Deficits in Communication and Information Transfer Between Hospital-Based and Primary Care Physicians: Implications for Patient Safety and Continuity of Care. Kripalani S, LeFevre F, Phillips CO, Williams MV, Basaviah P, Baker DW. JAMA, 2007;297(8):831-841.

  5. Literature review of deficits of information transfer at discharge, and interventions to improve them. • Information gap • Suggested decreased quality of care at followup and adverse outcomes if poor information transfer occurs.

  6. Primary physicians report limited role. <3% involved, <20% notified Information at discharge: accuracy/completeness • JCAHO requirements: p. 832, first paragraph • Missing data common, readmission/compromise care? Pending tests 40%, 10% requiring action. Mechanics of Transfer • Formats: Database-generated, letter, discharge summary • Route: patient carried, faxed • Timing: JCAHO 30 days; ½ not available at FU appt, STAT dictate

  7. Content: PMD Ratings of Desired Information • Main diagnosis • Pertinent physical findings • Results of procedures/tests • Discharge meds with reason for changes • Followup arrangements • Pending tests and specific followup needs (*) • Information given to patient/family

  8. Conclusions Communication and information transfer is often suboptimal Interventions had limited effect on outcomes. Options for handoff policies and procedures: white papers and discussions

  9. Recommendations: Kripalani S, LeFevre F, Phillips CO, et al. JAMA, 2007;297(8):838

  10. Discussion Issues Obligations of both physicians- patient care/ continuity/information Contact and communication between physicians • Information exchange • Frequency • Mode • Value: respect and support, education Actions: Hospital-based change? Hospitalist policy; pager 6677

  11. Hospitalist Measures • Thorough dictations, templates • Contacting Primary Physician • Hospitalist Brochure • Handoff Policy: internal and referral

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