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Refining the handoff

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Fred N. Pelzman, M.D.,  in a piece headlined “Refining the handoff,”  in MedPage Today, discusses the tricky art of deciding how to discharge patients from the ER.

Among his remarks:

“We put massive resources in place to try and improve the continuity of our patients with their primary-care providers, which has always been fractured as the residents rotate away and spend less and less time in our practice. Therefore, appointment priority is given to the primary-care physician, and someone needs to clearly state why an exception to this rule is being made.”
And “{o}ne of the problems has been that, for a great majority of these appointments, .. protected emergency room follow-up rapid discharge appointments end up not being really useful, not really helping the patient, and often not being necessary at all.”

”Now to be honest, a lot of this may be unfair. It reminds me of the game of Post Office, where a message gets passed along and the substance of the message changes as it goes from mouth to mouth.”

”{W}e need to streamline and improve communications, we need to make sure that the right patient gets the right appointment with the right provider at the right time.”
“{One physician} told me about an idea he has been toying with, trying to involve the primary-care doctors themselves in a discussion with the emergency room provider, so that they can all agree on the goals of these rapid discharge appointments.
“It is essentially a primary-care consult, with the goal of deciding what type of access, with what sort of acuity, and with clear questions asked to be answered.”

“In hashing this out, we came up with the idea of the emergency room doctor who is preparing to send a patient home speaking on the phone with one of our primary-care physicians, and having an actual conversation, a warm handoff, answering a preset group of questions to help make sure these patients get the care they need.
Does each patient have a primary-care doctor? Does the emergency room provider think the patient needs to be seen within X number of days? Why? What is it that you want us, as the outpatient primary-care provider, to assess, to follow-up on, to rethink?”

To read all of Dr. Pelzman’s piece, please hit this link.

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