Hospitalists and primary care physicians: Strategies for keeping in touch

With the rapid and sustained growth of the hospitalist movement, cooperation between teams of physicians becomes all the more important. Sharing information on patients' charts and discussing treatment and discharge strategies make for easier patient transitions to and from the hospital and promotes continuity of care during and following hospitalization.

Because of the many variables to patient care, doctor-doctor communication calls for flexibility. Patrick J. Cawley, MD, chief medical officer at the Medical University of South Carolina and immediate past-president of the Society of Hospital Medicine, recommends that hospitalists ask primary care physicians how they prefer to handle patient-related communications.

An EMR facilitates information exchange, but smooth transfer of information is doable without them. "Some primary care doctors and hospitalists stay in touch via the telephone," Cawley says. "Most prefer fax messages or secure e-mails. The hospitalist will dictate a note on admission, for example, and the hospital will get that note typed up and electronically transmitted or faxed to the primary care physician within 24 hours."

Bringing patients into the communications mix usually helps allay their anxiety. "The acutely ill patient is less likely to feel confused or abandoned if the primary care doctor endorses the hospitalist system in general and individual hospitalists in particular," says pioneer hospitalist John R. Nelson, MD, who directs the hospitalist program at Overlake Hospital in Bellevue, Washington. For elective hospital stays, Nelson recommends that the primary care physician prepare the patient by saying something like: "During your hospitalization I've arranged for Dr. Smith to take care of you. He's an excellent physician, knows his way around the hospital, and will answer whatever questions you and your family have. He and I work well together."

At the same time, consultants recommend that primary care physicians whose practices are exclusively office-based take a proactive approach and give new patients a handout indicating that if they require hospitalization they'll be seen by a hospitalist, but care will revert to the primary care doctor when the patient leaves the hospital. That way, even patients who enter the hospital via the emergency department will have some idea of what to expect.

Some hospitalist groups provide patients and their families with a brochure that describes what hospitalists do, explains the benefits of being cared for by an inpatient specialist, and indicates that hospitalists and primary care physicians exchange information about the patient frequently. The Society of Hospital Medicine has a sample brochure on its website (go to http://www.hospitalmedicine.org/AM/Template.cfm?Section=Practice_Resources&Template=/CM/ContentDisplay.cfm&ContentFileID=1667).

A hospitalist group's website can also provide patient information and reassurance. The "About Us" section of the website for Sierra Hospitalists ( http://www.sierrahospitalists.com/aboutus.htm), a 20-physician practice in Reno, NV, indicates that a hospitalist "serves as the admitting/attending physician for [inpatients], coordinating all aspects of their hospitalization, conferring with the primary care provider every step of the way."

To avoid communications breakdowns, Donna Knapp, Sierra Hospitalists' chief operating officer, advises hospitalist groups to set clear expectations for how and what information the hospitalist relays to the primary care doctor. These communications should include notifying primary care physicians when one of their patients is admitted, when major inpatient procedures and tests are performed, if there's a significant change in the patient's status, and when a patient is discharged or transferred. A detailed discharge summary, with specific follow-up recommendations, is a must.