Last week I had a patient in the hospital who had to stay 24 hours longer than I thought she needed to stay because it was difficult for nursing staff to contact all the doctors that were providing her care and clear the discharge home order. Essentially, I came in to make rounds and the patient wanted to go home. She was eating, having BMs, and was in no pain, and she felt that she would get better rest at home. I reviewed her chart and agreed with the patient that she could go home. However, I wanted to coordinate her care with all the other consultants who had helped on her case, such as pulmonary, ID, hospitalist, and general surgery. Aside for writing an order "d/c home if OK by pulm, hospitalists, ID, and general surgery services" I had no efficient way to convert the order to action.
To make a long story short, it took 18 hours to contact all the consultants and to finally get an OK for the discharge and then another 6 hours to make arrangements to actually get the patient home.
I have a better way. Doctors or their services ought to use SMS. I could then send one text message to all 5 consultants-or their services--and then the doctor could simply reply "yes" "no" or "?" to me and then I'd give the order, or not. I think it would save time and simultaneosly improve care to patients and communication amongst consultants and primaries.
Ain't gonna happen, but it would be nice.
To make a long story short, it took 18 hours to contact all the consultants and to finally get an OK for the discharge and then another 6 hours to make arrangements to actually get the patient home.
I have a better way. Doctors or their services ought to use SMS. I could then send one text message to all 5 consultants-or their services--and then the doctor could simply reply "yes" "no" or "?" to me and then I'd give the order, or not. I think it would save time and simultaneosly improve care to patients and communication amongst consultants and primaries.
Ain't gonna happen, but it would be nice.
6 comments:
I do use it on a limited basis with Hospitalists to coordinate care of patients. Works extremely well. Need to set up ground rules, such as making sure acknowledging receipt of msg, and must use discretion when including pt information (security). Getting in touch with a physician should not be the reason to hold up a pt's discharge.
Collection and sharing of private physicians' cell phone numbers may be difficult though.
Great idea. We use it at somerset medical center. Easy, but impersonal, way to get info across and contact important consultants. I agree that privacy is an issue. I would rather talk to the physician directly.
Excellent idea, but I think you are right in the fact that it is hard to accomplish. We had one ID physician that wouldn't round until 9 or 10pm. His patients would sit there all day waiting to go home...seemed like a waste of a patient bed for most of the day.
but wouldn't the consultants lose the rounding fee for that hospital day if they have not actually seen the patient?
I pick up the phone and call them personally if there is any question about delay of discharge. It may take me 1/2 an hour to get it all done, but you save the patient 18 hours of hell and the hospital frees up a bed, which adds value to my service as a hospitalist.
Do you really need the input of everyone who was involved? Often you can tell from the previous notes or plans what needs doing or can judge that no further input is necessary and/or useful. This has you on the hook for the decision but is certainly warranted in many cases.
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