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Patient safety after hospital discharge challenging

Doctors and hospitals should focus on short-term steps to protect patients, an expert panel says.

By Kevin B. O’Reilly — Posted Nov. 6, 2009

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One in five patients discharged from the hospital experiences an adverse event within three weeks. Two-thirds of those outcomes are drug-related, with many of them potentially avoidable, according to a recent report issued by an expert panel of internists, hospitalists and emergency physicians.

The group said that major changes to the health delivery system, such as electronic medical records and payments rewarding the medical home model, could help address the problem. However, the group said physicians and hospitals should not wait before making changes on their own.

The Transitions of Care Consensus Policy Statement was issued by the American College of Physicians, the Society of Hospital Medicine, the Society of General Internal Medicine, the American Geriatrics Society, the American College of Emergency Physicians and the Society for Academic Emergency Medicine.

The panel said hospitals and outpatient physicians should be held accountable for properly transitioning patients, coordinating care, involving family in decision-making and communicating key information in a timely fashion. The group also called for national standards and performance metrics.

It proposed that the following elements about patients should always be communicated as quickly as possible:

  • Principal diagnosis and problem list.
  • Medication list, including over-the-counter items.
  • Medical home or transferring physician or institution and contact information.
  • Patient's cognitive status.
  • Test results and pending test results.

The panel's recommendations were published jointly in August in the Journal of Hospital Medicine and the Journal of General Internal Medicine (link).

The recommendations come on the heels of increased scrutiny of how well doctors and hospitals prevent readmissions. President Obama has proposed bundling payments for hospitalization and care delivered within 30 days after discharge, penalizing hospitals with high one-month readmission rates. The administration says the move would save $8.4 billion and give hospitals more financial incentive to reduce the 20% 30-day readmission rate among Medicare patients.

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