As the academic year starts out, the interns have arrived and started to rotate through our ambulatory practice. During orientation we touch on the unusual concept of sending patients home.
How different this is from the inpatient world. Pretty much everything the team tries on a patient, a new medicine, or a procedure, the patient sticks around to see if it works, to see if the desired effect happens.
What’s different about the outpatient world is that we almost always send our patients home. We’ve learned as outpatient doctors to trust our instincts, to trust our patients, to trust the system, to build in safeguards, and in the end to hope that everything goes okay.
This is yet another example of those tricky transitions of care, fraught with uncertainty, as we move the patient from one world to another. From the inpatient world to home. From a nursing facility back to our practice. From our office to home. From the emergency room to the inpatient world.
Safe and efficient transitions of care are what matter here, so that everyone knows what you were thinking and what to do with whatever the results are, no matter what they are.
We are working with our emergency department colleagues, as well as the hospitalists on our inpatient services, to improve these handoffs from one world to another. Ideally, what we are building will be a better handoff, a warm handoff, with ongoing monitoring
If we are not given the resources to do this, and most importantly the time to do this, then we can never really tell patients that it’s safe to send them on their way.
But if we craft a truly safe and patient-centered transition plan, where most of the eventualities and unexpected things have been anticipated, then our interns ultimately will be happier letting people go at the end of the day, the ER will be more comfortable sending patients home, and our patients will be better cared for.
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Fred N. Pelzman, MD, of Weill Cornell Internal Medicine Associates and weekly blogger for MedPage Today, follows what’s going on in the world of primary care medicine. Pelzman’s Picks is a compilation of links to blogs, articles, tweets, journal studies, opinion pieces, and news briefs related to primary care that caught his eye.