All Entries in the "Patient care" Category
Patient hand offs more about skills than checklists
As I continue to research patient hand offs for an upcoming article in Hospitalist Leadership Advisor, I’ve realized that hand offs are less about forms, tools, and checklists and more about having good communication skills.
I know I’m guilty of assuming that other people can read my mind from time to time—we all are. I recall asking my husband if we could go to the curtain store one day to pick out some shades for the dining room. We were on the highway for quite some time before he asked, “Where’s the curtain store?” Of course! I know where it is because I’m a home deco diva, but he had never been there before. I assumed that because I knew, he knew, and I probably would have been mad when he blew by the exit. Sounds trivial, but when it comes to patient care and physician relationships, these details are critical.
Here are three tips that I’ve picked up from my sources that will not only help practicing hospitalists improve the quality of patient hand offs, but also help leaders brush up their every day communication skills.
Explain your rationale: When handing patients off to another hospitalist, explain what symptoms prompted you to order certain tests, and be sure to tell the hospitalist taking over the care of your patient exactly what they need to look for when the test results come back. Don’t just say “Order texts X, Y, Z.”
Repeat back information: To ensure that your understanding of an issue matches the other person’s intended meaning, repeat back what they’ve said to you. You do this with driving directions, right? (So, I’m taking a left on to Mason St. and a right at the blinking red light.) So why not incorporate this strategy into your clinical work or leadership activities? “Repeat-backs have not only been shown to improve patient safety and prevent errors, but they also enhance memory,” says Vineet Arora, MD, MAPP, Assistant Professor of Medicine, Associate Director Internal Medicine Residency, and Assistant Dean Scholarship & Discovery at the Pritzker School of Medicine, University of Chicago.
Don’t assume a note will suffice: If you’ve ever left a note for a family member to pick up milk, you’ve probably been disappointed. That person either never got the note or didn’t know whether you wanted skim, 2%, or whole. “You are able to communicate better, richer information more effectively through the verbal communication channel than any other communication channel,” says Arpana Vidyarthi, MD, Director of Quality and Safety in the Division of Hospital Medicine, Director of Patient Safety and Quality Programs GME, Director of the Institute for Physician Leadership, and Associate Professor of Clinical Medicine at the University of California, San Francisco.
For more tips and advice for improving patient hand offs, look for your January issue of Hospitalist Leadership Advisor, a supplement to Medical Staff Briefing.
I can’t get no sa-tis-fac-tion
Patient satisfaction is going to emerge soon as an issue for hospitalists. Communication with doctors is one of the components of the federally-mandated HCAHPS surveys for hospitals, and payment may eventually be linked to that measure.
Administrators are very sensitive to complaints, and more of them seem to be generated by hospitalist service patients than other services. The reasons are not hard to understand; the hospitalist usually has no prior relationship with the patient, may not know the preferred communication style for that patient, and is under pressure to reduce length of stay and conserve hospital resources.
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The “one-visit follow-up clinic”
A frequent impediment to reducing length of stay with the unassigned (or “no-doc”) patients is the lack of an outpatient physician with whom the patient can get an appointment. In many, many places around the country, primary care physicians have overflowing practices and cannot take on the unassigned patient very easily.
One solution to this dilemma is what I call the “one-visit follow-up clinic”. At Inpatient Management Inc., we are about to launch our first such clinic. The idea works like this: we, as the hospitalist team, will provide one follow-up visit to patients who do not have a primary care physician. The clinic might see patients two half-days per week, depending on volume, and can be staffed by a nurse practitioner with supervision from one of the hospitalists.
OB hospitalist programs: What the field has to say
I did an interview with Rob Olson, MD, an OB hospitalist practicing in Spokane, WA, to follow up on “Four tips for an effective OB hospitalist program” in the November issue of Hospitalist Leadership Advisor, a supplement to Medical Staff Briefing. Olson is the administrator and moderator of http://obgynhospitalist.com.
Susan Rutherford, medical director or Women’s and Children’s Services at Evergreen Healthcare in Kirkland, WA, also chimed in with her thoughts. I’d love to hear yours, too!
LJ: How is operating an OB hospitalist program different than a traditional internal medicine hospitalist program? Are there any special considerations?
RO: There are many similarities in all hospitalist programs. The differences between internal medicine (and for that matter, pediatric) hospitalists and OB hospitalists are that OB hospitalists perform surgery, have more urgent and emergency patients, have more consultations from family practitioners and midwives, and overall request fewer consultations from other specialists.
Leadership essential to preventing medical errors, says Joint Commission
We all know that good leadership can help the physicians that medical staff leaders work with everyday, but now, The Joint Commission says that effective leadership can prevent medical errors, in an Aug. 27 Sentinel Event Alert.
Healthcare leaders, including chief executives and senior managers, are the ones who should promote a culture of safety, according to the alert.
Inadequate leadership can cause 50% of medical errors, according to a 2006 Joint Commission alert.
The new alert includes a 14-step process to prevent medical errors and recommendations to follow accreditation standards.
“Leaders must recognize that all sentinel events involve a failure in the systems and processes which led to the event,” said Jeff Selberg, CEO of Exempla Healthcare, in the alert. “As leaders, we are accountable for those systems and processes which provide the framework for the clinical environment our staff works within.”
How has your organization's leaders shaped better patient care? Comment below.
R-E-S-P-E-C-T : This is What it Means to Me
Most hospitalists were not yet born when Aretha Franklin recorded the lyric, “R-E-S-P-E-C-T – Find out what it means to me.” Still, the song remains popular and captures quite well the drive for legitimacy in hospital medicine. Many hospitalists do not feel respected, not by specialists who want to dump patient care responsibilities on them, not by hospital administrators who deny them fair compensation and appropriate staffing, and not by patients wanting to know why their doctor is not seeing them. The secret of gaining respect is to show respect to others.
Many older physicians resent the changes that have occurred in medical practice and regard hospitalists as part of the problem, not as part of the solution. The key to getting along with these doctors is to show that you value the things that they consider important, most particularly the physician-patient relationship. Start by sitting down with them in the cafeteria and the doctors’ lounge. Listen carefully to what they say, and you will learn a lot about the history and traditions of the hospital. Some things may be outdated, but you will discover that most of the rules and procedures of the medical staff were developed for very good reasons that remain valid today.
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Contest entry: Physician hotline for patient and physician satisfaction
Keeping patients and physicians happy sometimes requires some creative thinking. We liked this tip that came from Gloria Ziegler, CPCS, medical staff services director of Val Verde Regional Medical Center.
Gloria says that her institution strives to improve patient and physician satisfaction. How do they accomplish that goal?
The Val Verde Regional Medical Center currently uses a physician hotline for physicians to call reference any complaints, praises, or new ideas that might be helpful in improving patient/physician satisfaction.
She says,
“We also have established a patient/customer hot line to deal with any concerns that our community might have dealing with their care at our facility. Our administration works extra hard to assure that anyone having concerns or issues which need to be resolved are addressed in a timely manner. We are the only facility in town within a 300-mile radius and must work extra hard to keep our patients from going to San Antonio or San Angelo for care.”
Thanks for sharing!
Keep those contest entries coming, and you could win the free registration to The Greeley Medical Staff Institute Symposium (Nov. 8-9, Naples, Fl)!
We’ll share the entries on the blog and select the best one at the end of the month.
To enter the drawing, submit your best practice, tool, or tip to us. Find more details here!
Are concierge hospitalists coming?
I recently had the opportunity to have lunch with a member of the board of directors of a company called MDVIP and was fascinated by their business model. MDVIP helps primary care physicians transition from a traditional practice model to a concierge practice. This company was featured in a recent article on CNNmoney.com.
Here are some of the basics of MDVIP as I understand them:
- The patient pays an annual retainer of approx. $1,500 or $125 per month
- The practice limits the number of patients to between 300—600
- The physician is accessible to any patient around the clock by cell phone and will even meet the patient in the emergency room when an emergency arises
- The patient keeps his or her health insurance in place
- The patient must take an annual “Mayo Clinic” level physical, and the practice focuses on wellness and prevention
What’s the number one duty of a hospitalist? Patient safety?
When Robert M. Centor, MD, did his morning rounds, he found one patient named Jones in one room, and another patient also named Jones in the next room. That was a mistake waiting to happen, said Centor, associate dean for the Huntsville Regional Medical Campus of the University of Alabama, School of Medicine, in Birmingham, in an interview with HealthLeaders Media I conducted last week.
That’s where the true value of the hospitalist comes in.
“Hospitalists will help the C-suite improve patient safety,” said Centor, who is the voice behind the DB’s Medical Rants blog. Given that hospitalists practically live in the hospital, they are the go-to people for consistency of care and operations.
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Resident hospitalists in teaching hospitals
It has been very interesting to me to watch the explosive growth of the hospitalist movement. Among the most interesting has been the use of hospitalists in teaching institutions. At some of these hospitals, the residents ARE the hospitalists that primarily serve unassigned patients. However, many (if not most) teaching hospitals also have a large number of private practice physicians on their medical staffs; this is where it can get interesting.
In my experience, private practice physicians often hesitate, if not outright refuse, to have residents see their patients because of their concerns regarding quality, patient satisfaction, or the permanent loss of the patient to faculty practice plan physicians. In these cases, there is a segment of the medical staff that does not have access to a hospitalist program unless it uses the residency program’s “hospitalists”. Sometimes, this will cause the medical staff to send their patient to other hospitals where they can access a hospitalist program without concern.
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New handoff guidelines from SHM
I’m writing a case study for the September issue of Hospitalist Leadership Advisor (supplemental newsletter to Medical Staff Briefing) on a hospital that has developed a hybrid scheduling model. Basically, physicians spend one week on hospitalist duty and three weeks practicing in their outpatient offices. Naturally, I asked about patient handoffs—I figure if you’re not going to be back for three weeks, you should have a darn good system in place. And they do—hand-written notes are not allowed (electronic documentation only, thank you), and physicians discuss patient handoffs either face to face or over the phone so that there are no hanging questions. To boot, every Monday morning starts with a case conference.
Happenstance, I later ran into the Society of Hospital Medicine’s new recommendations for patient handoffs in the July issue of ACP Hospitalist. How many of these can you check off?
Hospitalists should:
There’s no such thing as the “right” number of patients—but you can get pretty close
In its July issue, Today’s Hospitalist dove into the quandary that hospitalists have been facing since day one: what is the right number of patients to see per day? This isn’t ninth grade algebra (which I flunked, by the way) where you can discover the value of X by plugging certain values into a predicable equation. In fact, multiple factors go into deciding how many patients a single hospitalist or a group should see in a single day.
There is, of course, patient load, but what about group culture, scope of practice, and experience? Then there’s ED call, the availability of advance practice professionals and other clinical support, and physicians’ willingness to see the standard 15 patients per day.
Rather than trying to create a benchmark for productivity—which can sharpen your math skills but may not get you very far in the physician satisfaction arena—should hospitalist groups start asking physicians how many patients per day they are comfortable seeing?
John Nelson, MD, also chimes in on this subject on his blog.
What’s your ideal patient census number?
