A hospitalist friend recently moved from that “Silo” of care to the Post-Acute/Long-Term Care (PA/LTC) “Silo” of care in my community.  He rather quickly saw things in the new setting of care likely not apparent to his hospitalist colleagues.  While I readily agreed, he decided to routinely provide feedback to referring hospitalist by cc of his dictated admission H&P and Discharge Summaries to them.  I had previously given up on doing that since the hospital EHRs in my community (Meditech & EPIC) haven’t a place for post discharge records in their EHRs.  However, by sending it to specific hospitalists, they will initially get feedback on what occurred on their PA/LTC patient referrals.  I’m now including that strategy in my dictated reports.

In addition, I just received a complicated patient directly out of a 2 week ICU stay who was coming for rehabilitation rather than the usual palliative care.  The Intensivist wisely insisted on talking directly to the receiving physician (myself), which made for a great handoff and greatly relieved the patient and spouses anxiety about this transition (poor prior experiences).  I wonder if our admission intake coordinators should encourage physician to physician handoffs on complicated patients.  As a receiving PA/LTC physician, I am much better prepared.  In addition, finding all of the meaningful information scattered through 50-100 pages of redundant electronic medical records can be challenging.

Lastly, in my community, discharge summaries for our PA/LTC patients are typically cryptic hand written notes done off site days to weeks after discharge and aren’t passed on to the receiving physicians.  Because I do voice dictated discharge summaries prior to discharge with the details about the patient’s care and post discharge care plan (a billable service 99315 & 99316), I have routinely sent copies of this report to the receiving PCP and consultants.  While I have not measured the value of this service, I have received very positive feedback from the downstream providers. 

As PA/LTC medicine becomes better defined as a specialty and as our facilities care outcomes become more public, the things we can do now to break down the “Silos” of care should pay long term dividends.

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