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The Hospitalist’s Role in Post-Acute Care

From my article in the April issue of ACP Hospitalist

As he pulled into the hospital’s parking garage before work on a recent morning, hospitalist Ryan Greysen, MD, thought about one of his patients slated for discharge that day, a middle-aged man recovering from a major stroke. The stroke had caused dramatic and sudden changes in the man’s cognitive and functional abilities, and he was about to undergo an extensive period of rehabilitation in a skilled nursing facility (SNF).

“I did the best I could to ensure a really good handoff to the receiving MD but, ultimately, I wondered, ‘Why isn’t it easier for me to remain connected to this patient and his family?’” said Dr. Greysen, a hospitalist at the University of California San Francisco (UCSF) medical center.

Photo by Thinkstock

Photo by Thinkstock


It’s a familiar dilemma for many hospitalists. When seriously ill patients are discharged to SNFs for rehabilitation or ongoing care, physicians might like to spend more time on the discharge process, but they’re often forced to hand off some of the details in order to focus on other patients and new admissions.

“As hospitalists, we try to provide really good care for our patients as they’re leaving the hospital, but we wind up feeling stuck and frustrated because often we’re working against a system that’s not set up to work that way,” said Dr. Greysen. “We unintentionally but understandably get disengaged.”

Over the past decade, hospitals have implemented multiple successful interventions aimed at reducing preventable readmissions, but those reforms have largely focused on systems rather than individual physicians, noted Dr. Greysen and Allen Detsky, MD, PhD, in a perspective in the October 2015 Journal of Hospital Medicine.

As a result, hospitalists often lack the guidance and support they need to fully engage in postdischarge planning.

In addition to lack of time, hospitalists often have too little information about post-acute care options to make informed decisions, said Leora Horwitz, MD, MHS, FACP, associate professor in the departments of population health and medicine at New York University School of Medicine. Until recently, it has been difficult for hospitalists to access details on the type or quality of care provided at the different facilities to which they routinely refer patients.

“We have historically done a poor job of understanding the differential outcomes at various nursing homes,” said Dr. Horwitz, who studies transitions of care. “Tracking outcomes and giving feedback to community facilities is relatively new, and it could make a real difference in the kind of care patients get.”

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