The Current and Futrure Patient Discharge Enviroment.

Traditionally, primary care physicians have admitted their own patients, provided hospital care (in addition to seeing outpatients during the day), and followed patients after discharge. Under this model, continuity of care has been preserved; however, this method of care has faltered under the weight of inpatients and outpatients with more severe illnesses, rapid technological advancements, managed care pressuring outpatient physicians to see more patients, and a thrust toward reduced hospital costs and length of stay.

Needs of Proper Patient Discharge Notification.
  • - Guaranteed communication between the health professionals involved in your discharge.
  • - Timely delivery of pertinent health information at the time of discharge.
  • - Additional layer of security reminding physicians of pending tests and required follow up.
  • - Mitigating risk in the greatest hazard area known as the “The boundary of care”.
Current Patient Transistion of Care Envirorment.

Unfortunately, a standard, universal mechanism to communicate patient discharge information and transfer physicican responsibility has not existed before. This is where Sign Out Now has bridged the gap to provide effective, trackable and recorded patient information to physicians on a universal level.

Current flawed communication at the time of discharge includes the following:
  1. No communication between the Discharging Physician and the Accepting Physician.
    1. Majority of cases
  2. Occasional communication between Discharging Physician and Accepting Physician
    1. At discharge from the hospital, only 3-20% of the time is there direct communication from hospitalist to Primary Care Physician (1).
  3. More than 50% of all preventable adverse events that occur soon after discharge can be traced to poor communication.
  4. Accepting Physician relying on the discharge summary to be available at the time of the patients evaluation.
    1. Just 12-33% of discharge summaries were available to the Primary Care Physician at the time of the first visit. (2)
    2. Only 25% of discharge summaries mentioned pending tests and only 13% mentioned all pending tests. (3)
The Sign Out Now Solution.
  1. Communication on every patient discharge.
    1. Finalize at time of discharge who is the receiving physician and notify them. No guess work involved.
    2. Solves the challenge of getting doctors to answer the phone by leaving either a voice or written message AP can listen to as time allows.
    3. Allows for contact information to be exchanged between DP and AP.
  2. Track your Medicare discharges.
    1. Currently there are 47.6 million Medicare beneficiaries with an estimated 9,100 individuals added to the program each day. (4)
    2. CMS estimates it will pay $600 million for transitional care services in 2013, with the majority going to PCPs.
    3. CMS estimates PCPs will receive on average 7% increase in Medicare payments due to the new coder.
  3. Reduce readmission rates.
    1. The Medicare Payment Advisory Commission (MedPAC), which reports to Congress, has estimated that 12 percent of Medicare patients may be readmitted for potentially avoidable reasons.
    2. Medicare will levy $227 million in fines against hospitals in every state but one.

By standardizing the communication process between physicians at the time of discharge, we are improving both quality and safety of care.

Bibliography
  1. 1)  Kriplani S, Jackson A, Schnipper J, Coleman E. Promoting effective transitions of care at the hospital discharge. J osp med. 2007; 2 (5): 31-323
  2. 2)  Roy cl., Poon eg, Karson as, et al. Patient safety concerns arising from test results that return after hospital discharge. Ann intern med. 2005; 143:121-128.
  3. 3)  Were m, li x, Kesterson j, et al. Adequacy of hospital discharge summaries in documenting tests with pending results and outpatient follow up providers. J gen intern med. 2009;24(9);1002-1006.
  4. 4)  Kaiser Family Foundation, 2011 statehealthfacts.org and AARP 2011 projections.