Handoffs Smoother in Rural Communities


Before Matthew Schreiber, MD, became chief medical officer of Piedmont Hospital in Atlanta, he was director of hospitalist services for the four-hospital Piedmont health system, and before that, a hospitalist for the system’s smallest hospital, 35-bed Piedmont Mountainside in Jasper, Ga., population 2,000, so he knows just how different transitions of care are between hospitals large and small.

In many rural communities, the hospitalist concept has only recently been introduced, and patients are accustomed to PCPs being responsible for all of their medical care. But it can be easier to achieve high-quality handoffs in rural areas because the number of physicians involved is much smaller, Dr. Schreiber says.

“At Piedmont Mountainside, only eight physicians made most of our referrals. It was possible to memorize their office numbers and their call-coverage arrangements,” he explains. Some doctors are accessible 24 hours, seven days a week, while others take their patients’ charts home overnight in case they get called. This encourages an individualized approach to communicating with them. “It makes the care feel more personal, with a different level of accountability,” Dr. Schreiber says. “You feel a connection to the patient and the doctor—and that your job isn’t done when the patient goes home.”

Rural hospitals and doctors also tend to have closer relationships with community services like home health agencies. “We can give the medication list to the home health nurse and say, ‘This is what we think the patient is taking. We want you to go in and find out what they’re actually taking and reconcile the two,’ ” Dr. Schreiber says.

However, small and rural hospitals—particularly stand-alone and critical access facilities—are less likely to have computerized tools for automating and facilitating care transitions, Dr. Schreiber says. In some cases, the rural hospitalist carries a pager and takes calls 24/7.

Dr. Schreiber says it’s important to hand patients a piece of paper that summarizes their condition, key events in the hospitalization, and new medications, all in patient-friendly language, to take home and post on the refrigerator. “In our experience, patients hold onto this document and bring it to the doctor’s office or even to the emergency room,” he says, adding that if the formal discharge summary doesn’t reach the PCP in time, this summary could be a godsend.

Visit our website for more information about local and national efforts to improve care transitions.

Check out the SHM website for information on Project BOOST (Better Outcomes for Older Adults through Safer Transitions), a national QI initiative to improve handoffs and transitions.

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