Tuesday, March 17, 2009
Brian Jack, an associate professor of family medicine at the Boston University School of Medicine, says he heard too many stories of patients' leaving the hospital with insufficient instructions -- such as the woman who wasn't told that the blood-pressure-lowering drug prescribed at discharge replaced the one she had at home. She took both and was soon back in the hospital with kidney failure, Jack says.
So his team of researchers launched a study comparing two groups of patients heading home from the Boston Medical Center. One group, of 370 patients, received spoken and written information from a specially trained nurse and a follow-up call from a pharmacist several days after leaving. The other group, which had 368 patients, got a less intensive review, no printout and no follow-up call. The more intensively trained patients had 30 percent fewer hospital readmissions or emergency room visits, according to results published recently in the Annals of Internal Medicine.
For now, no standards apply to what a discharge program should entail, but the BU team has developed a checklist that hospital patients can use as they exit.
Be sure to ask about, and get written answers on:
-- why you were hospitalized.
-- what medicines to take and how to take them.
-- what to do if your condition changes.
-- whether the hospital will set up follow-up appointments, or whether that is up to the patient or caregiver.
-- how to get information on tests for which results were not ready at the time of discharge.
Some hospitals have set new discharge standards of their own. At Suburban Hospital in Bethesda, for example, the staff uses a computer-based program to provide a printout of customized instructions for each outgoing patient, including recommended follow-up care. "The software allows us to incorporate instructions [including ones for medications] from many departments," says Ronna Borenstein-Levy, a spokeswoman for the hospital.
-- Francesca Lunzer Kritz