1. Shabana khan MD

    Excellent recommendations, I will make sure to implement all of them in my practice , even if we forget one it will end up in the usual chaos at the time of DC

  2. M A Brumberg DO

    As a solo GP I gave up hospital practice and nursing home practice because it was impossible to run from place to place in order to get things done the way they both wanted and left it to the Hospitalists.
    They get the denials for LOS, I get them about them as a courtesy.
    What is a problem though is when things get dumped on me. Things that should have been arranged before discharge instead of getting calls from family as to why PT was not ordered or home
    Nursing visits were not ordered or that the spouse or significant other is not able to take care of the patient upon returning to the home. It is very difficult to arrange for a placement in an extended care facility when the patient is an outpatient not an inpatient. This commonly happens to senior citizens with few of any caregivers available to help daily ADLs.

  3. Aaron Goldstein

    I think you make some excellent points, and all are valid. The issue can be that the system isn’t always working cohesively to attain such goals. For instance, assuming that a patient will be able to access those services that can be safely performed outpatient, whether it’s transportation, insurance, or other psychosocial obstacles. Sometimes it can be a struggle coordinating all thr details of this access as thr hospitalist – it’s critical that we try and institute a structure of comprehensive care coordination from top to bottom – strong care management and social workers are a must!

  4. Vinicius Sabedot Soares

    Good point, Aaron. Actually, patients are getting more complex ever, so the hospitalist can`t do all the job alone. Care coordinators and integrated multidisciplinary team are cornerstone for better patient care.

  5. Sharlyn J Hjelmstad

    Agree completely. A team approach through multi disciplinary lens, ensuring everyone is aware of expected discharge date, patient needs, barriers such as resources and support are essential to achieve a timely discharge. Communication early, and often, with constant identification of “next steps” in plan of care allows the care team to crosscheck and progress accordingly. Keep in mind payer delays can also be a huge delay when the target date is not proactively shared, as authorizations can take 2-4 days to return and most come with a short expiration date and will have to be resubmitted for if the discharge date moves out too far.


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