Sixth, we believe that the ultimate sign-out, the sign-out to the primary care physician on discharge of a patient, is just as critical as any in-house sign-out process. The Hospitalist Services at Decatur Memorial Hospital utilizes General Electric’s Centricity EMR, an electronic medical record system. With modification of the program, we perform our histories, physicals, and discharge summaries electronically.
We have modified the software so the discharge summary serves a triple purpose: The summary serves as a discharge instruction for the patient, including medication reconciliation with electronic prescription printout, as well as instructions for diet, follow-up care, and ancillary services. Secondly, the discharge summary is electronically sent to the medical records department to fulfill the discharge summary requirements of the hospitalization. Finally, the discharge summary is electronically mailed to primary care physicians who have Centricity EMR and is faxed to those who do not. All of these goals are achieved prior to patient discharge. And, as an additional courtesy, all primary care physicians receive a phone call in order to add a human element.
The success of DMH’s Hospitalist Services is directly attributable to the continuity of care that our schedule provides. The hospitalist model was a new concept among the medical staff at Decatur Memorial Hospital. It was met with skepticism among our primary care physicians, mostly because of the strong relationships the physicians had developed with their patients. With the continuity of care provided by our model, however, we were able to market the Hospitalist Services with great success.
“The continuity of care was something my group was very concerned about when we decided to utilize the services of our local hospitalists,” says Michael Wall, MD, FAAFP, who is part of a DMH call group consisting of six family practice physicians. “Prior to our move to the hospitalist model, we would normally cover our own patients throughout the week and sign out to the on-call physician in our group for weekend coverage. Those sign-outs were very detailed and specific, including the nuances involved in [the] care of our ‘special’ patients.
“When we began using the hospitalists, Dr. Yu assured us that the same high quality service that our patients have come to expect from us would continue, including [in] the area of continuity of care,” he explains. “Since our transition, both the physicians and patients have been pleased with the high level of service delivered by our hospitalists. The Hospitalist Services has truly kept their promise to us on all the issues we were most concerned about. Our patients are happy, and our group physicians are happy. It has been a win-win arrangement for everyone.”
According to James Neviackas, MD, who was head of nephrology at DMH before being recruited as a hospitalist in Hospitalist Services, “Actually, the patients in our service receive better continuity of care than the primary care model, since there are no changes of service, even on the weeknights or weekends.”
The obvious major disadvantage of the DMH model is the fact that the hospitalist is on continuous pager call for seven days. But it has been our experience that the incentive to “tuck in the patient” to minimize after-hours pages continuously challenges each hospitalist to optimize medical care for the patient. This is especially true for the critically ill patient, because DMH is a regional tertiary center, and our Hospitalist Services act as accepting physicians for regional transfers to our institution.
We have been successfully recruiting physicians as we expand our services, and our model has not been a source of candidate qualm, even among physicians coming out of residency. What has helped tremendously in the acceptance of our model has been the fact that three out of our four hospitalists have been in a solo practice environment and are used to the concept of continuity of care; they do not see it as a burden but as a duty.