Today I'd like to direct your attention to an article in the Health and Wellness section of AlterNet by Niko Karvounis. Karvounis is a Program Officer with The Century Foundation in New York City where he works on issues of socioeconomic inequality and health care. He is also a regular contributor to the Foundation's health care blog.
In his article, he examines a chronic health issue, but not diabetes or obesity, instead he casts his eye upon the mistakes made when a patient is transitioned from one health care provider to another.
Even the most common hand-off -- your standard referral from primary care physician to specialist -- is not risk-free. As Dr. Bob Wachter recently noted in his blog, "in more than two-thirds of outpatient subspecialty referrals, the specialist received no information from the primary care physician to guide the consultation." Sadly, the radio silence goes both ways: "in one-quarter of the specialty consultations," Wachter says, "the primary care physician received no information back from the consultant within a month."In the era of our nations "non system" of health care, the discontinuous and fragmented nature of treatment poses many opportunities for mistakes to enter the process, often to the detriment of the patient.
These missteps are indicative of what can go wrong during the hand-off, such as, according to QSHC, "inaccurate medical documentation and unrecorded clinical data." Such misinformation can lead to extra "work or re-work, such as ordering additional or repeat tests" or getting "information from other healthcare providers or the patient" -- a sometimes arduous process that can "result in patient harm (e.g., delay in therapy, incorrect therapy, etc)."
Kourvanis delineates a pattern in which most of the gaps in care are communications failures and most of those are on the part of primary care physicians. To provide context, he does examine the plight of primary care doctors, doctors whose workload is mammoth and pay miniscule by comparison to others in their profession. Combined with the fee for service system currently in place, these inequities are a recipe for disaster.
He examines a variety of possible changes that could improve the system, in the end reaching this conclusion:
But for all that these ambitious changes hold promise, the hand-off will always exist -- which means reformers need to dig deeper and develop protocols at the operational level. Luckily, they're doing just that. Kaiser Permanente, for example, has created a procedure meant to formalize communication between health care teams when a patient is transitioning from one provider to another.He goes on to look at a variety of situations and programs designed to minimize or eliminate these errors. He looks at post discharge coaching, electronic medical records, Kaiser's SBAR program and more.
Go give it a read. His article is packed not only with food for thought, but also with an amazing a array of data and hyperlinked resources.
SOURCE: "21st Century Medicine Wrought with Miscommunication and Human Error" 03/20/08
photo courtesy of Ninjapoodles, used under this Creative Commons license