The U.S. Society of Hospital Medicine stated that in the year 2000 there were roughly 3,500 hospitalist physicians practicing. In 2015, this number has risen to over 52,000 and is likely to continue increasing. The Doctors Company, a large professional provider of liability insurance, says that having these designated hospital-based physicians on-hand has improved care; however, many incidents of preventable malpractice are attributed to failures in “handoffs” of patients between physicians. A report analyzing 2,100 hospitalist-related medical malpractice claims showed that the claims were much more likely to be of a severe nature than compared to other medical specialties. The inability to obtain critical clinical data contained in a medical record is a prevalent source of claims in the U.S.
Approximately 12% of these suits resulted from a breakdown in communication between the patient (or their family) and the doctor. Increasingly, challenges in communication-based on language barriers have risen due to shifts in demographics. Often the handoff between private-practice physicians and hospitalist physicians is the problem. The key patient data in many cases simply does not get transmitted, or the transmission is not executed in a timely manner. Patients with lengthy medical histories may arrive at the hospital without documentation of their conditions, and many are unable to recall their current medications and why they are being prescribed.
Having a hospitalist available to provide care for patients is best when the levels of communication are high between them and the patient’s other doctors. Coordinating this in-hospital care in a safe manner presents dangerous challenges. Procedures and policies must be put in place to reduce confusion and often harmful delays in administering care. If the hospitalists have access to an electronic medical record of the patient, they are able to comprehend the scope of care needed. Primary care physicians are encouraged to remind patients to carry a current listing of medications and other information with them to present in an emergency room setting.
Hospitalist physician groups are increasingly sending summaries of patient discharge to their doctors. The hospitals themselves often place calls to the patient after discharge to follow-up on their instructions, address potential questions, and gauge the progress of recovery. Alan Lembitx of COPIC pointed out that in today’s economic environment, hospitals may be financially penalized if a patient regresses and must be admitted back to the hospital within a period of 30 days. The Doctors Company clearly recognizes the consequences of having no external patient records available in the hospital. Roughly 35% of instances involving errors in initially assessing a patient occurred in the absence of such data. David Troxel, Medical Director with The Doctors Company, explained that proper collaboration in identifying the communication problems are the key to limiting malpractice cases.