Moving Out

The Hospitalist. 2005 October;2005(10):

October 1, 2005 | The Hospitalist

SHM to Provide Discharge Guidelines

SHM received a grant from the John A. Hartford Foundation to examine and improve the geriatric discharge process. A group of volunteer researchers are compiling information from three demo sites to create quality indicators around care transitions. In 2006, their findings will be available to benefit other SHM members in the form of a toolkit for discharge planning. This toolkit will include a process guideline, or checklist, for hospitalists to apply in their own organizations.

“A process guideline is unusual in healthcare,” admits Dr. Halasyamani, who is involved in the grant project. “Guidelines are usually clinical. SHM is working on several other initiatives that will also become process guidelines for key issues.”

SHM will hold a workshop on “Transition of Care” at its 2006 Annual Meeting, May 4-5, Washington, D.C. Visit www.hospitalmedicine.org for more details.—JJ

EMPOWERED PATIENTS

One change we are likely to see is patients taking on the responsibility of their own medical information. Ideally, the patients themselves will make caring for—and discharging—them easier and more efficient by sharing complete information on their current medications and other healthcare details that are often forgotten or overlooked by a provider or caregiver.

“The future of discharge lies with our ability to arm patients with their own information,” says Dr. Arora. “The more empowered the patient is, the better the outcome.” Personal health records (PHRs) are one solution. MyPHR is one online product, offered free by the American Health Information Management Association (AHIMA). Roughly 30 companies currently offer paid subscription PHR services to consumers. Peoplechart Corporation (San Francisco) is one of them and provides a single source of information controlled by the patient.

“We’re a pioneer of the PHR idea,” says Megan Mok, president and founder, Peoplechart Corporation. “There are not that many out there.”

Healthcare consumers can subscribe to a variety of Peoplechart tools and services (including initial collection of their records) that allow them to gain access to their comprehensive medical records via the Internet—or phone, if they choose—and to grant any given healthcare provider access to part or all of their records.

“Everything is patient-initiated and patient-controlled,” explains Mok. “There’s a big difference from systems controlled by providers, which may allow patients access, but not ownership.”

PHRs typically offer a comprehensive, integrated overview of an individual’s health data, including information that individuals add themselves on their symptoms and prescriptions, along with information such as diagnoses and lab results. Once a discharged patient updates her PHR, she can share her complete hospital records with her primary care physician, physical therapist, rehab facility, or whatever caregiver requires the information. This will save time and effort for all healthcare providers, and, more importantly, ensures that essential information is available.

Regardless of whether a patient has a PHR, physicians and other staff must ensure that the individual leaves the hospital with complete information on their care and medications.

“Discharge is a quality measure,” says Dr. Arora. “We need a multidisciplinary approach to address what each patient needs to go home.”

In the hospital of the future, the discharge process will involve a multidisciplinary team, which will ensure that the patient is ready to leave the hospital, informed about their condition and any next steps, and has necessary medications or prescriptions in hand.

DEMYSTIFIED MEDICATIONS

In the very near future, the 2006 JCAHO standard for medication reconciliation will eliminate many problems with medications after discharge.

“This standard is extremely important,” says Dr. Rosenman. “Almost half of medication errors occur at transition points in a patient’s care. Reconciling medication lists—especially at these points—is critical to ensuring patient safety.”