Two Research, Hospital Innovations, and Clinical Vignettes (RIV) scientific posters presented at HM13 shed new light on the opportunities and challenges of hospitalist-run post-discharge clinics, which a growing number of hospitals have adopted in an attempt to smooth care transitions and prevent rehospitalizations.
The Denver VA Medical Center (VAMC) started its post-discharge clinic, located on a floor above its medicine wards, in 2003. Open two afternoons, the clinic sees up to 16 patients a week. Discharging housestaff are paged to meet their patients in the clinic as part of required afternoon activities, explains the poster’s lead author, Robert Burke, MD, a hospitalist at the VAMC and assistant professor of medicine at affiliated University of Colorado. Every patient is seen by a rotating, supervising hospitalist attending.
The clinic is able to see patients for their first post-discharge clinical encounter within five days on average, much sooner than either urgent care clinics (9.4 days) or primary care physicians (13.7 days).
However, data presented at HM13 found no reduction in readmissions for the VA clinic’s patients.1 Dr. Burke suggests that this finding reflects the challenges of connecting patients to their PCPs after the clinic visit. “Also, it’s not a full, multidisciplinary clinic—just housestaff and attendings,” he says. “The patients we see in the clinic are very ill.”
A second poster from the same team presented data from a national survey of hospitalists’ attitudes regarding post-discharge clinics.2 Three-quarters of 228 respondents believed that these clinics would reduce ED visits, but only 38% said that hospitalists should be seeing patients after discharge, and about 75% said doing so should require additional compensation for the physician.
“In my experience, I find it very valuable to see patients post-discharge as part of the larger continuum of care,” Dr. Burke says.
Larry Beresford is a freelance writer in San Francisco.