Pending lab tests are not in hospitalist discharge summaries

As hospitalist programs become more prevalent, the issue of how best to communicate discharge summaries and instructions to primary care physicians remains.

A recent study suggested that only 16% of pending lab tests were written in hospitalist discharge summaries, which is a staggeringly low number.

Doctors who see hospitalized patients in follow-up need to know what they’re looking for; whether it’s abnormal potassium level or the result of an imaging study that hasn’t been read yet.

According to the study’s lead author, “it’s a problem that’s being exacerbated by the growth of hospital medicine for two reasons: More and more patients are seen by separate inpatient and outpatient physicians, and sicker patients are being discharged sooner from hospitals.”

An obvious solution would be unified electronic medical records, where primary care doctors can easily look up results during a post-hospitalization visit. But that’s currently a fantasy. My clinic, for instance, uses a different electronic system than the two local hospitals, both of which uses different systems from each other.

And that’s not even considering the increasing number of patients who simply don’t have primary care doctors to follow-up with.

Some hospitals have post-discharge clinics where hospitalists do the follow-up themselves, but that’s not commonplace. We clearly have a ways to go in bridging  the communication gap between hospitalist and outpatient physician.

(via David Williams)

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  • http://drpullen.com Edward

    I stopped doing my own inpatient care a year ago, and now use hospitalists. I’d settle for just a discharge summary dictated when patients are discharged. As it is I usually get the summary a couple of weeks after I see them in follow up. I have to depend on whatever labs and test results I can get faxed from the hospital medical records and the patients recollection. This plus a scribbled hand written note they bring with them. This is clearly not optimal care. The care in the hospital is generally good, but the transition back to the office is sketchy. I don’t think this is isolated to our community.

  • Erik

    A lot of the pending labs no longer matter. Admit a patient with cough, fever, chest pain, abnormal x-ray. Blood cultures negative; 50 tests sent to figure out what is in his chest – autoantibodies, fungal cultures, AFB smears, ACE level, and so on.

    Broch grows strep pneumonia; pt better on 3 days of IV rocephin. No one cares what is still pending; we know what was wrong and how to fix it now.

    If the PCPs want the DC summary dictated on the day of DC (a reasonable request) then we need more hospitalists. If you’re supposed to see 30 pts a day – 10 in the ICU, 15 on the floor and 5 on rehab, then the DC summary won’t be done until your day off – no time. Take it down to a managable # (18 or so) and then everything gets done in real time. That’s all about staffing.

  • RuralDoctor

    The hospital I work at will not release my same day discharge summaries until I sign them. So if I do several discharge summaries on day 7 of 7 and then have 7 days off, there will be no discharge summary for the PCP. Going in on my day off would be an hour drive each way and uncompensated. I asked why we cannot release unsigned pending discharge summaries and was told “that’s not how we do it.” And you can’t sign them from home either. Ridiculous.

  • LynnB

    I rotate through hospitalist weeks , about 6-8 yearly as well as “full time” practice.I see it from both sides

    Typically, patients are admitted by one hospitalist . We are lucky, we get outpatient records about 75% of the time, the full timers don’t know how to read them , they are the typical goobledegook written for insurance auditors and opaque to clinicians . The information you need may be there if the doc has time after looking up the code for cough and tobacco abuse , to write in that they worked in a TB hospital in the 50′s and got 6 months of something or other.

    If the admission is off hours there is an immediate hand off to the rounding team .They may be discharged by the same hospitalist, or if the stay crosses the Monday change of shift, someone new. There may be tests ordered by a consultant or someone cross covering. Some poor souls are in for many weeks .

    If I pick up a patient on Monday I have to hunt for what the last hospitalist ordered.Tthere is no way to do that for send out labs in our WWII era hospital EMR lab system . I don’t dictate it because sometimes I don’t know about it . It shocks me that the lab has no way to pull up what is pending on a given patient. You can see if an ACE level or and AFB is still pending but you have to know that they are ordered . It also shocks me that its hard to change who the reports are directed to.

    When I receive patients there is no summary–our drafts get released, but there is a big lag before they are transcribed . They have a med list laboriously prepared by a pharmacy tech. This is in EXCEL format . It can’t be emailed because of HIPPA . Even if it could be securely mailed we have to have the same system for all the docs (JCAHO) so we can’t do that either unless we pay for everyone to have access. Hiring several pharmacy techs or LPN’S to update the 3 different outpatient EMR’s with the dictated list would be too cheap, insure too much consistency and free up too much physician time. I guess doctors are cheaper because they don;t need to pay us overtime. Instead its gets done by the doc in the office after the visit, based on incomplete information. I KNOW why we don;t hire more people in the office . Under the new regime, we get “credit” only for office visits not for EKGs we do and interpret, PFT’s, Labs , injections , neb treatments IV meds (all profitable). I keep doing these things because they avoid admissions, are cheaper, faster and less hassle for the patients and give me data that helps me care for the patient in a timely manner , but then I run behind-er and behind-er.

    I , too would settle for less. A med list would be nice . But coming at form the hospitalist end , we do try .

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