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Twelve ways to improve hospitalist communication

From the January ACP Hospitalist, copyright © 2010 by the American College of Physicians

By Stacey Butterfield

Hospitalists spend more of their day communicating than they do actually touching patients, with 26% of practice time spent on the former and 18% on the latter, noted Donna K. Knapp during a session at the Medical Group Management Association’s annual meeting in Denver last October.

The statistic, taken from a recent workflow study, highlights the need to perfect the paths of communication in a hospitalist practice, with patients, staff members and clinicians, and each other. “Each piece is basic and we should know this already, but every day I see things that could be improved in my hospitalist communication program,” she explained. Ms. Knapp, an administrator with Sierra Hospitalists, LLC, in Reno, Nev., shared some tips that could be of use to hospitalist practice leaders. They include

  • Start with clear, detailed communication as soon as you hire a hospitalist. “I highly recommend that people set up a standard orientation process. Make sure the binder’s set so you know what you’re supposed to be talking to them about,” she said. That orientation should include issues like which payers your group sees patients for, for example.
  • Make introductions a part of orientation. “Each person in my group that I know is going to be interfacing with a physician at any point in their career—whether it’s for five minutes or every day—during orientation, that physician meets that person and talks a little bit.”
  • Choose, and make clear to all staff, the appropriate timing and methods of communication. “You don’t want a staffer e-mailing a hospitalist about their billing every day,” said Ms. Knapp. Decisions should be made ahead of time about which communications merit a page, a phone call or even a text, and when to discuss non-urgent issues (e.g., not during rounds).
  • Use communication tools. “Don’t reinvent the wheel,” said Ms. Knapp. Her practice uses a Google Docs online spreadsheet for charge capture and forms that have been developed by other practices.
  • Set up communication with primary care physicians. One of the forms that her group has borrowed is a fax sheet (developed by John R. Nelson, FACP) to notify outpatient physicians when their patients are admitted and discharged. While some hospitalist programs let the primary care doctor choose the means of communication, her group found that it was most efficient to fax all the updates. The group also gets a contact phone number for all of their referring physicians and keeps it available to hospitalists on the group’s internal Web site.
  • Communicate with doctors inside the hospital, too. To solve or avoid problems, Sierra hospitalists sometimes go to meetings of the emergency department and invite emergency physicians to their meetings. “Make sure the emergency room doctors are communicated with, so there’s not that admission dump at the end of ER shifts,” said Ms. Knapp.
  • Use the same language. “We’ve run into a situation where some nomenclature is different at one hospital than another,” Ms. Knapp said. Ensure all physicians in your program are using the same acronyms and abbreviations, for example.
  • Have a place to communicate. A hospitalist call room is a good spot to drop the mail and consult about cases without worry of a HIPAA violation. “In the hospitals where we don’t serve exclusively, we had to fight for it.”
  • Make sure patient communication is handled well. Ms. Knapp suggested running role plays with new or communication-challenged hospitalists to teach patient communication skills, including the use of touch and sitting down. “Patients perceive that more time is spent if the physician is sitting,” she noted.
  • Talk to the patient’s family in an organized way. “Ask for a family designee and phone number. You don’t want to be talking with five different family members about the patient,” said Ms. Knapp.
  • Know that clothes communicate, too. In addition to not dressing sloppily, hospitalist groups might find benefits in polo or dress shirts with the group logo. “It will advertise for your group, but also give the patients the confidence that they are being seen by a professional.”

In concluding, Ms. Knapp offered advice on the most persistent communication issue for hospitalist programs: handoffs. She recommended hospitalist leaders develop a handoff protocol and then go to their group for input. “You’re not going to get anything done trying to involve everybody on the first round,” she said. After the protocol is implemented, the use of it should be taught in training sessions, she suggested.

Although good handoffs include oral communication between hospitalists, ideally face-to-face but also on the phone, the medical record is an important component, too, Ms. Knapp said. “Make it a communication tool, not just a record of what you’re doing. Make sure that the things that are in your head, that we don’t know, are in that record.”

Getting all of the necessary information from hospitalists’ heads to where it needs to be will likely continue to be a major challenge. “The hospitalist system has inherent discontinuity of care and communication,” said Ms. Knapp, adding that she hopes the use of these tips will make the process a little smoother.

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