*Editor's Note: This article was written before the COVID-19 pandemic. The views expressed here are not reflective of those atypical hospital scenarios.
What hot topics and best practices in hospital medicine can you expect to hear more about in 2020 and beyond? We asked two experts for their take. Benjamin Frizner, MD, MBA, is Medical Director at BridgePoint Hospital in Washington, DC. David Fromberg, MD, is a hospitalist and family physician based in Marquette, MI.
Q. An often-discussed topic in hospital medicine is length of stay. How is this being addressed where you practice?
A. Dr. Fromberg: This is a metric that you see next to your name during hospitalist staff meetings. The length of stay for a patient involves so many different variables, most of which you do not have control over, including how social workers deal with placement, how consultants take part in patient care, taking over patient care from another provider, and pre-existing conditions. It is unfair to simply look at a number without considering these other factors.
Q. How do you see the length of stay issue playing out over the next five to 10 years?
A. Dr. Fromberg: Hopefully these metrics will be more reasonably calculated, as EMR systems are improved. This way, variables that are not under our control are factored in when calculating the result.
Q. Can you address value-based care, care coordination, and other efforts being implemented to improve outcomes?
A. Dr. Fromberg: My hospital is currently working to improve congestive heart failure readmissions. We have a committee made up of hospitalist team members, nursing staff, social work team members, and representatives from surrounding skilled nursing facilities. We are currently dealing with adherence to low-sodium diets. We can recommend them, but patients do not always follow them, so we are addressing this potential barrier. Staff weigh patients daily and reach out to intervene when certain measurement alerts are triggered. Weekend coverage is important for a program like this to be successful.
Q. What are the keys for hospitalists to practice successfully in this environment?
A. Dr. Fromberg: Be sure to keep up on the latest in treatment trends, have open lines of communication with team members to coordinate care, and easily view and track your own readmission data. Additionally:
• make sure that documentation such as discharge summaries are completed on the same day of discharge,
• check and recheck that patients have their medications, and
• have an action plan in place for when discharged patients start to head on a downward path toward being readmitted.
It is also important that patients provide their preferred pharmacy information. Better still, see that patients have the bedside medication delivery program in place prior to discharge. Finally, ask patients and family members to verbalize their understanding of an agreed upon action plan.
A. Dr. Frizner: Tracking 30-day readmission rates is controversial. Research suggests that physicians may delay sending patients back to the ED until they are out of the 30-day window. Also, hospitals are admitting patients under observation status instead of as inpatients and then expediting discharge so the patient does not fall into the 30-day readmission bucket.