An opportunity for hospitalists to improve patient care

Some hospitalists are in denial.  Some hospitalists have become methodologic critics.  But all hospitalists should take the findings of the recent Annals of Internal Medicine article seriously.  We should not argue about the article, but rather ask whether these findings point out a weak point in our care of patients.

This article provides an opportunity, not a scolding:

In an accompanying editorial, two other researchers from the VA Medical Center in Ann Arbor, Mich., agreed that the hospitalist model may not be working perfectly, but said it would be premature to call it a failure.

“Hospitalists have filled the gap left by residency work-hour requirements, and they frequently contribute to inpatient quality improvement efforts,” wrote Lena M. Chen, MD, and Sanjay Saint, MD, MPH.

“We need more studies that follow our patients wherever they go and help us practice the sort of coordinated care that is most likely to lead to high-quality outcomes,” they recommended.

This is a correct response.  The long standing program (started after these data occurred) for improving transitions of care between hospitalists and primary care physicians is a correct response.

If the safety movement teaches us anything, it tells us that we must accept inconvenient news and then first do a root cause analysis.  After the root cause analysis, we must perform trials on improving our performance.

The time frame of this study is potentially confusing:

Kuo and Goodwin obtained Medicare payment data on a random, nationally representative 5% sample of beneficiaries receiving care from 2001 to 2006. They limited the main analysis to patients receiving care at hospitals with at least 20 admissions involving hospitalist care and at least 20 in which nonhospitalist primary care physicians (PCPs) were in charge of care.

Any careful observer quickly understands how this might happen.  Any careful observer knows that we have 2 lesions – transfer of information to the hospitalist and transfer of information from the hospitalist.

Likely some hospitalists and some hospitalist programs handle these transitions well.  However, too many patients still “fall through the cracks.”  We spend too much repeating tests on the inpatient side.  We have too many patients present to their PCP without that physician understanding the recent hospitalization.  We lose some of the benefit of excellent hospital care.

The Annals article should be viewed as a wake up call.  I urge my hospitalist colleagues to avoid the ostrich mode, and embrace the study, developing creative methods for fixing the problems.

Robert Centor is an internal medicine physician who blogs at DB’s Medical Rants.

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