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The statistics are sobering: Nationwide, nearly half of all patients suffer from some sort of medical error upon discharge from a hospital. The errors — prescription errors, lack of a follow-up appointment with a primary care doctor, or failure to notify the primary care doctor of test results — are often caused by poor communication.
While those mistakes can lead to serious problems, even more serious errors caused by hospital negligence can follow patients out the hospital door. In some parts of the U.S., more than a quarter of hospital patients are readmitted within 30 days because of diagnosis errors, hospital-acquired infections or poor discharge continuity.
Doctor Mark Lachs, a geriatric medicine specialist and health blogger, the time patients are most vulnerable to medical mistakes isn’t necessarily while they’re actually in the hospital — it could be at the time of admission or discharge.
Sub-Specialty Culture Can Contribute to Poor Care Transitions
Our health care and hospital cultures have changed over time. When hospitals originated over a hundred years ago, the range of health care services was small and relatively simple.
Your family doctor was the person you consulted for almost all medical issues, and that doctor knew you and your entire medical history. Importantly, your family doctor either personally treated you in the hospital or followed your treatment closely.
Today’s sub-specialty culture means that patients may have multiple doctors who communicate with each other rarely, if at all. Primary care physicians rarely handle hospital care. They are also increasingly scarce and rarely have the time to get to know patients or proactively follow up on their hospital care.
One study found that, when patients had medical tests still pending upon discharge from a hospital, their primary care doctors were unaware of 62 percent of those tests.
Hospitals routinely rely on patients to provide complete and accurate information about their medical histories and what medications they are taking — often when patients are under heavy stress. That can be a source of serious errors: one study found that 54 percent of hospital patients misreported the medications they were taking at home. Many of those discrepancies had potentially life-threatening consequences.
Upon discharge, hospitals routinely give post-discharge care instructions directly to the patient, not to a primary doctor or nurse, often without providing someone to call if something unexpected happens.
When a troubling symptom arises after discharge, patients often panic or wait too long to get it checked. That results in both unnecessary emergency room visits and hospital readmissions.
Better, More Complete Communication Can Reduce Errors and Hospital Negligence
The good news is that the advent of electronic medical records may ultimately give doctors a more complete picture of medical histories and current medications. Many hospitals are working to develop better care transition procedures to improve discharge continuity and cut down on adverse outcomes.
In the meantime, patients can take some steps to protect themselves. Remember, an emergency room visit or hospitalization is a stressful time, and it’s hard to remember all that detailed medical information.
Make a list of your medications, medication allergies and other important information, along the contact information for your primary care physician and any specialists you are seeing. Keep it in a place where it’s easy to find and update it regularly.
Source: The Huffington Post, “Care Transitions: The Hazards of Going In and Coming Out of the Hospital,” Mark Lachs, M.D., Director of Geriatrics, New York Presbyterian Health System, October 21, 2010
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