She offers the example of a patient who resists the idea of using a walker. Sometimes simply demonstrating how much more quickly the patient can get around using the walker may do the trick.
Dr. Shaw adds that a certain level of sensitivity is required when approaching a patient who is in denial regarding his or her limitations. It may be necessary to ask a second physician or nurse to lend credibility by explaining to the patient again that he or she may have needs that didn’t exist previously. He cautions, however, that if his patient remains in denial about his or her limitations, he does not hesitate to engage the family. “If the patient is discharged home, it’s going to be the family who will be the policemen and watchdogs,” says Dr. Shaw.
After discharge, following up with the patient can make a big difference in patient compliance. The time following discharge to the home can be confusing for the patient, and he may be overwhelmed with changes in routines, medications, and activities. Dr. Shaw’s organization calls the patient three to four days post-discharge to verify that the patient understands the discharge instructions, to answer questions the patient may have, and to confirm that prescriptions have been filled and that follow-up appointments have been made with the primary-care physician. He notes that although this simple follow-up phone call takes little time and effort, it has improved patient satisfaction immensely.
Quality and Prevention Initiatives
The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) 2007 National Patient Safety Goals for hospitals includes the following goal: “Reduce the risk of patient harm resulting from falls” (Goal 9).
The requirement for this goal is the implementation of a fall reduction program, followed by evaluation of the effectiveness of the program. Drs. Wald and Shaw agree that, because of the nature of what they do, hospitalists are in an ideal position to spearhead the movement to assess the reasons a patient may have fallen and the risk for future falls—both in the hospital and following discharge—and to synthesize that data to create comprehensive falls prevention programs in their hospitals.
Because hospitalists are on-site 24 hours a day, seven days a week, they are usually first responders when a patient falls and can best evaluate the reasons for the fall and track outcomes. “We’re in an ideal position to create protocols for what to do once a patient does fall in the hospital and [to] evaluate the fall and the incident,” Dr. Wald says. “This is a great quality improvement project because the data are already being collected.”
Dr. Shaw concurs. “Hospitalists are the quality assessors that are in the trenches,” she says. “The hospitalists are really the clinicians most familiar with the strengths and weaknesses of any institution.” TH
Sheri Polley is a medical journalist based in Pennsylvania.
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