A P P E N D I X E Sample Communication Plan for a Hospitalist Program COMMUNICATION WITH PRIMARY CARE PHYSICIANS At Admission The emergency department (ED) physician speaks with the referring primary care physician (PCP) (Dr. X). If the decision is to admit, the hospitalist is contacted. If possible, the PCP provides the patient with a brochure explaining the hospitalist practice; otherwise, this is done by the hospitalist. The hospitalist writes an order in the chart to Notify Dr. X that the patient has been admitted. When desired by the referring PCP, or as necessary for clinical reasons, the hospitalist may call the referring PCP directly. The referring PCP s office is called by the hospitalist or administrative staff person at the hospital and notified of the admission. The staff at the referring PCP s office automatically retrieves the patient s office chart and faxes the most recent records to the hospital to be placed on the chart. 243
The hospitalist dictates a history and physical at the time of admission; it is transcribed within hours and faxed to the referring PCP and placed on the inpatient chart. The admitting order form completed by the hospitalist provides a checklist of other outside records that are requested by the hospitalist. The hospitalist staff (e.g., rounding assistant) follows up to get these additional outside records. Prior inpatient records are made available to the hospitalist in the ED or the hospital unit. The hospital makes every effort to identify the referring PCP to facilitate the communication of test results, etc. During the Inpatient Stay The hospitalist and the PCP communicate by telephone only as needed. An effort is made to reduce the number of times the hospital staff pages the hospitalist by o leaving notes for the hospitalist on a communication sheet in the patient s chart o each unit accumulating nonemergent pages and contacting the physician approximately every two hours o as much as possible, grouping the inpatient team s patients within the same units At Discharge Hospitalist discharge summaries are dictated, transcribed, and faxed to the referring PCP before the close of business that day (unless discharged late in the day). The patient is given a discharge summary when appropriate (e.g., when uncertainty exists surrounding patient s follow-up physician). 244 Appendix E
All hospitalists use the same format for discharge summaries to make it easier for PCPs to find pertinent information in the document. The hospitalist phones the PCP when necessary or when desired by the PCP. The test results pending at discharge and any recommended follow-up evaluations (e.g., check prothrombin time/inr [international normalized ratio]) twice a week until stable in therapeutic range) are highlighted for the PCP in the discharge summary. Patients discharged to skilled nursing facilities (SNFs) should have clear notes identifying the responsible physician in the SNF. COMMUNICATION WITH THE PATIENT, FAMILY, AND HOME CARE PROVIDER The hospitalist describes the hospitalist referring PCP partnership to patient and family. A hospitalist brochure is provided to the patient on admission. The brochure contains o pictures of the hospitalists with brief biographical sketches o how to contact the hospitalist o the relationship between the hospitalist and referring physician, including how the two communicate o why the patient is under the care of a hospitalist instead of the patient s personal physician (i.e., advantages of the hospitalist model) o what the patient and family can do to maximize the chances of a good outcome from the hospital stay (e.g., follow-up with referring physician, compliance with prescribed treatments) The hospitalist clarifies with the patient, family, and home care provider when to contact the PCP and when to contact the hospitalist if questions arise. Appendix E 245
The administrative staff person contacts the hospitalist (e.g., by text message) regarding incoming questions about previously discharged patients. The hospitalist outlines expectations regarding daily visits, availability for family meetings, status updates, and timely discussion of test results and management decisions. The hospitalist uses lay terms and language that foster patients understanding of their condition. The hospitalist coordinates and/or provides complete patient education regarding the plan of care upon transition from the hospital. The hospitalist may consider calling patients after discharge to review discharge instructions, medications, and follow-up instructions. The hospitalist may consider providing the patient with a copy of the discharge summary and other relevant documents at the time of discharge (often possible if stat transcription is available) or later via mail. COMMUNICATION WITH NURSES AND OTHER HEALTHCARE STAFF Create a daily listing of hospitalists on duty, corresponding beeper numbers, and the patients they are following. Distribute this to all nursing units, the hospital operator, and any other party who may need to know, such as the hospitalist practice manager or rounding assistant. Ensure that the hospital chart clearly indicates which hospitalist is seeing the patient daily. This requires an entry in the physician orders and/or progress notes section when a change occurs in which the hospitalist is seeing the patient. Consider designating teams of hospitalists and label charts accordingly. Then one pager number can be assigned to each team, simplifying the mechanism of contacting the appropriate hospitalist. 246 Appendix E
Display the hospitalist monthly schedule at nursing units and at the hospital operator switchboard. COMMUNICATION AMONG HOSPITALISTS Written and concomitant verbal sign-out of patients at change of shift is most effective. Elements to consider in the handoff include o patient identification o active problems/medical history o active medications and allergies o venous access status and contingencies o pertinent laboratory data o concerns for next 18 to 24 hours o psychosocial status, long-term plans, and code status Hospitalists can consider making themselves available via beeper to other hospitalists for special questions that may arise once they leave the hospital. Appendix E 247