In a Venn diagram, patient handoffs would fall at the intersection of quality improvement (QI), patient safety, and technology.
Vineet Arora, MD, MPP, FACP, FHM, associate professor of medicine at the University of Chicago, wants hospitalists to understand that best practices in transitional care only work efficiently if they incorporate pieces from all three spheres. Hospitalists who focus too much on the outcome of an individual case might fail to utilize technology that could create a systemic protocol that would improve outcomes across multiple cases, she says. Similarly, hospitalists who leave notes in an electronic health record (EHR) can mistakenly believe that the next physician will interpret that information perfectly despite a lack of verbal and physical cues that guide verbal communication.
“People may fall into the fallacy that electronic health records actually equal good handoffs,” says Dr. Arora, a faculty member at HM12 last month in San Diego who led a breakout session that focused on the obstacles of handoffs. “The challenge is that handoffs actually are about a verbal exchange of informationa conversation and a dialogue, in conjunction with and supplemented with written communication. Technology certainly has the ability to revolutionize the way we review information and access information, but it will not change the way we speak about the information.”
The crossroads of patient safety, QI, and the use of technology from medical devices to iPhones was a major theme at SHM’s annual meeting, April 1-4 at the San Diego Convention Center. Hospitalist leaders agree that clinicians must focus on all three tenets to improve healthcare delivery, particularly in the face of generational healthcare reform. But they also acknowledge that finding a balance between best practices, budget and staffing constraints, and the rigors of daily practice is difficult.
Hospitalist Mark Lyons, MD, who works on residency programs and a patient-handoff initiative at Methodist Health System of Dallas, says that sessions on QI and patient safety provide new ideas from industry leaders who are in the trenches. To wit, he was impressed by the suggestions from Dr. Arora’s handoffs session as she described cases in which she was involved.
“They understand the limitations and the other things that go along with doing the actual act itself,” Dr. Lyons says. “They understand those things and take them into consideration. And you appreciate that.”
He and other hospitalists at HM12 agree that when leading practices are promoted at national forums, they take on the imprimatur of evidence-based procedures that physicians want to bring back to their respective HM groups. And QI suggestions promoted by physicians, not management, often tend to be more readily accepted.
“When you force change upon people, then it really leads to resistance,” Dr. Lyons says. “These are good opportunities to learn different strategies, to learn easier ways to present new ideas to people, to encourage them to do better, and to make it easier for them to do those things.”
Anuj Dalal, MD, FHM, a hospitalist at Brigham and Women’s Hospital in Boston, says technology can range from global EHRs across a multiple-institutional health system to microblogs to practice-centered wikis that promote communication between physicians. But integrating those technologies into care delivery that improves outcomes hinges not on technical hurdles, but on physicians accepting their validity and utility, he says. Once clinicians start digitally codifying the informal communication tools they currently use, patient-specific communication can improve.
And while Dr. Dalal, who co-led a session on the use of wikis as a communication-management strategy, adds that despite the little research linking those technological tacks to patient outcomes, he believes they are related.