Safety in numbers: Physicians joining forces to seal the cracks during transitions

Abstract

Disclosure: Nothing to report.A lack of communication and accountability among healthcare professionals in general, and physicians in particular, jeopardizes quality and safety for our patients who are transitioning across sites of care.1,2 Our patients, their family caregivers, and our health care professional colleagues on the receiving end of these transfers are often left ''flying blind'' without adequate information or direction to make sound clinical decisions. Beyond our attempts to ensure effective transitions on a professional level, many of the readers of the Journal of Hospital Medicine likely have struggled to ensure seamless transitions for our families, despite the benefits of our training and experience. If some of the nation's most respected healthcare leaders are unable to make this work for their loved ones, 4-8 one can only imagine the challenges faced by those without such advantages. National and local quality collaboratives aimed at improving communication and collaboration across settings have found physicians difficult to engage as partners in these efforts. 9 All too often there is a false expectation that these types of activities are best left to nonphysician healthcare professionals on the sending side of the transfer or to those receiving the transfer. 10,11In this issue of the Journal, we commend the leadership provided by representatives of 6 of the nation's leading physician professional societies to join forces toward the common purpose of articulating physicians' roles and accountability for care delivered during transitions.12 Ensuring effective care transitions is a team sport, yet rarely do we have a clear understanding of who are the other members of our team, how to interact with them, or a clear delineation of their respective roles. Simply stated, this article is a key step to facilitating teamwork across settings among physicians, our interdisciplinary healthcare professional colleagues, our patients, and their family caregivers. These standards clearly convey the type of care we expect for our loved ones. Drawing from proven strategies used in nonhealthcare industries, the standards assert that the sending provider or institution retains responsibility for the patient's care until the receiving team confirms receipt of the transfer and assumes responsibility. Further, the receiving team is given the opportunity to ask questions and clarify the proposed care plan in recognition of the fact that communication is more than simply the transfer of information. Rather, such communication involves the need to ensure comprehension and provide an opportunity to have a 2-way dialog. These standards distinguish between the transmission of information and true communication.The timing of the release of these standards is ideal. As physicians concentrate their practice within particular settings we can no longer rely on casual random interchanges in hospital parking lots or the hospital's physician lounge. Rather, we need to take a more active and reliable approach to ensuring timel...

Transitional Care

“…Team work to alleviate missing "cogs" and create a loop of safer and higher-quality continuous care for our patients is required. When speaking of transition "hand-offs" Dr. Coleman (2009) states "Our patients, their family caregivers, and our healthcare professional colleagues on the receiving end of these transfers are often left 'flying blind' without adequate information or direction to make sound clinical decisions." The opportunity for HHA nurses and pharmacists to bring "sight" and "shine a bright light" on this process is enormous.…”

Sociodemographic and clinical factors associated with antidepressant type in a national sample of the home health care elderly

“…While a large proportion of patients were taking an AD without an accompanying diagnosis of depression or other mood disorder, medical records may fail to include medical diagnoses because of coding or transcription errors, or diagnoses being dropped when a patient transitions into HHC [29-31] . This may be particularly relevant to patients who have recovered from a previous clinical depression and are currently receiving ADs for prophylaxis.…”

Comparative effectiveness of direct admission and admission through emergency departments for children: a randomized stepped wedge study protocol

“…Both are associated with significant stress to patients and their families [8,9]. While hospital discharge processes have been the focus of tremendous research, policy, and quality improvement efforts, research determining the quality of care at the time of hospital admission is scant [5,9,10]. As a result, hospital admissions expose patients to many of the same risks that have been the focus of hospital discharge reform: unstructured patient handoffs, poor communication between healthcare providers, and inefficient care [5][6][7].…”