Transcript Hospitals, Home Health and Hazards

Hospitals, Home Health and
Hazards
Karen Jeselun, RN, BSN
Hospitalist Role
Hospital Practice
 Internal Medicine or Pediatrician
 Employee vs. Contractor

Primary Care Physician Role
Office Practice
 Specialty Varies

Risk Management Concerns
Arizona Revised Statutes: 32-1401: 24 “Unprofessional
Conduct”
(Q) Any conduct or practice that is or might be harmful
or dangerous to the health of the patient or public.
This includes discharging a patient from the
hospital who will require ongoing care that was imparted
while under the care of the Hospitalist. This is considered
abandonment.
(SS) Prescribing, dispensing or furnishing a prescription
medication or a prescription-only device as defined in
section 32–1901 to a person unless the licensee first
conducts a physical examination of that person or has
previously established a doctor–patient relationship.
Is this a problem?
YES!
Survey data from the Arizona
Association for Home Care shows that
30% of patients discharged to HHAs
without attending physicians are readmitted to hospitals within 72 hours.
Solutions on the Horizon
Hospitalist Stakeholders Taskforce
Membership
Arizona Medical Association (ARMA)
Arizona Association for Home Care
Health Services Advisory Group
MICA
Arizona Hospital Association
Arizona Osteopathic Association
Arizona College of Emergency Physicians
Arizona Nurses Association
Solutions on the Horizon
Hospitalist Stakeholders Taskforce
Membership continued….
Arizona Hospice and Palliative Care
Organization
Blue Cross Blue Shield of Arizona
Hospitalist Groups
Various Hospital Systems
Solutions on the Horizon
Taskforce Goals




Prevent the discharge of patients from the
hospital without appropriate arrangements for
continued outpatient care.
Facilitate the transfer of patients from the
hospital to the outpatient setting in a seamless
fashion.
Prevent the occurrences of medical errors and
patient misunderstanding during this transition
period.
Assist the hospitalist in finding an outpatient
physician to assume patient care.
Solutions on the Horizon
Algorithm
 Liability Decision
 Forms
 Web site Development
 Ongoing Physician Education
 And ???

IMMEDIATE ATTENTION–HOSPITAL FOLLOW-UP PLANS
HOSPITALIST - DISCHARGE TRANSITION FORM
Hospitalist Physician ____________________________
PCP _____________________________________
Back Line Pager Phone # ________________________
Back Line Pager Phone # ___________________
Patient/DOB __________________________________
Health Plan ______________________________
Date Admitted/Re-admitted ______________________
Date Discharged___________________________
PCP Called
Yes
No
PCP Called
Yes
No
Discharge Diagnosis:
1. _______________________________________ 7. _______________________________________________
2. _______________________________________ 8. _______________________________________________
3. _______________________________________ 9. _______________________________________________
4. _______________________________________ 10. _______________________________________________
5. _______________________________________ 11. _______________________________________________
6. _______________________________________ 12. _______________________________________________
Chronic Medical Problems:
1. ____________________________________________________________________
2. ____________________________________________________________________
3. ____________________________________________________________________
4. ____________________________________________________________________
5. ____________________________________________________________________
6. ____________________________________________________________________
Allergies: ______________________________________
HOSPITALIST - DISCHARGE TRANSITION FORM CONTINUED . . .
Discharge Medication:
Name
Indication:
NewDoseFrequencyIndication/Plan/Duration12345678910
Follow up date: _______________________
With: ________________________________________________
Plan of care: _________________________________________________________________________________
Follow up concerns:____________________________________________________________________________
Consultants Involved:
None
1. ________________________________________________________________________________________
2. _________________________________________________________________________________________
3. _________________________________________________________________________________________
Pertinent Lab/X-Ray/Procedures
Results
1. _________________________________________________________________________________________
2.__________________________________________________________________________________________
3. _________________________________________________________________________________________
Complications/Adverse Reaction/etc.
1. _________________________________________________________________________________________
2. _________________________________________________________________________________________
3. _________________________________________________________________________________________
*See Release on Reverse
_______________________________________
Signature - Hospitalist
________________________________________
Signature - PCP
IMMEDIATE CONFIRMATION REQUESTED
PCP COMMUNICATION FORM – ADMISSION
Revised 1/1/04
Hospitalist Physician ____________________________ PCP _____________________________________
Patient Name __________________________________ Health Plan ______________________________
Date Admitted/Re-admitted ______________________ Date Discharged___________________________
1.
2.
3.
4.
5.
6.
Admission Diagnosis:
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
1.
2.
3.
4.
5.
6.
Chronic Medical Problems:
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
Medications:
1. ___________________________________________________________________________________________
2. ___________________________________________________________________________________________
3. ___________________________________________________________________________________________
4. ___________________________________________________________________________________________
5. ___________________________________________________________________________________________
6. ___________________________________________________________________________________________
7. ___________________________________________________________________________________________
8. ___________________________________________________________________________________________
9. ___________________________________________________________________________________________
10. __________________________________________________________________________________________
Last OV: _______________________
What Can You Do?
Facilitate communication between
hospitalists and PCPs.
 Promote the use of the ARMA Web site
 Promote the use of the Hospital
Discharge forms
 Participate in physician educational
forums

Questions?
Thank you!
RESULTS of AAHC SURVEY
APRIL 15, 2003
17 respondents
1. How often do you find the “referring” physician will not be the “attending” physician
who will be signing the POC (485) ?
Less than 10% of the time
30%
10% - 25% of the time
10%
26% - 50% of the time
10%
51% - 75% of the time
20%
76% - 100% of the time
30%
2. Have home health admissions or delays in treatment been affected?
Less than 10% of the time
10% - 25% of the time
26% - 50% of the time
51% - 75% of the time
76% - 100% of the time
40%
30%
20%
10%
0%
3. What have you done to get the patients the care that they need?
Persistence in making multiple phone calls to any and all physicians the patient has ever seen.
Involve hospital case managers.
Adamant with discharge planners about needing a physician to follow the patient’s plan of care prior to acceptance of the patient.
Plan admission visit after the physician has seen the patient.
4. Have patients been sent back to the hospital within 72 hours due to not having a physician to cover?
Yes 30%
No 70%
5. Are there specific physician practices in your community who are willing to take new
home care patients? (Please define these groups, such as residents who work with a teaching hospital, etc.)
Yes 70% but with restrictions that they see the patient first
50% answered – private physician
50% answered – group practices
No 30%
RESULTS of AAHC SURVEY CONTD…
6. Do you have a relationship with a Physician(s) who is willing to oversee the care of your
home health patients who do not have a Primary Care Physician?
Yes 30%
No 70%
If yes, please explain: Medical Director on rare occasions, ED physician, Hospitalist with
Own practice.
7. Some physician groups do not feel qualified to care for the complex needs of home
health patients, but are willing to become knowledgeable in the various types of treatments. I.e. Lovenox.
Please list the top five medical therapies your patients need:
(Listed in the order of most frequently mentioned)
10 Wound care
8 Diabetic care
7 Lovenox
4 Ortho Rehab
3 Fragmin
2 Medication management
2 Respiratory medication management
1 IV’s
1 Post – surgical management
1 Symptom management
1 S/P chemo
1 Dialysis complications
1 Enteral feedings
1 Ostomy care
1 Hypertension
1 Urinary cath care
1 Compression wraps