When 62-year-old Rod Larson of Minneapolis was found to have a rapidly worsening bacterial skin infection, his primary care doctor immediately sent him to the hospital.
On arrival, Larson was put in a room and examined by a physician assistant. He didn’t stop at the admissions office because his information and treatment orders already had been placed into the hospital computer system.
Larson was subsequently seen by an internal medicine hospitalist, an infectious-disease doctor and an orthopedic surgeon, who conferred regularly about his care over the next four days. He required 12 days of intravenous antibiotics after discharge; medical supplies were delivered within an hour of his arrival home. A nurse followed shortly to teach him how to administer the medication and give him a 24-hour phone number for a nurse and pharmacist.
The medical teamwork and smooth discharge Larson experienced is known as good coordination of care. It occurs when health-care providers work together to organize care activities; share information with each other, the patient and his caregivers; and agree on their respective roles. Without good coordination of care, risks for medical error rise significantly.
Orly Avitzur, medical adviser to Consumer Reports, offers this advice on how to make sure your doctors are doing it right:
Have a primary care doctor. If you have more than one chronic condition, you’re likely to see more than one doctor. The more complicated your health, the more health-care providers enter the mix. A primary care physician (PCP) can help facilitate the sometimes choppy communication among your specialists. You can ensure that your PCP is in the loop by asking each specialist to send your records and visit notes to him or her.
Chronic conditions? Pick a care coordinator. As of January, doctors can bill Medicare for time spent coordinating care for patients with multiple chronic conditions. The doctor most involved with your care may be the right choice (you can choose only one), but it’s up to you. Your doctor may bring up the subject, but if not, simply ask whether he or she will serve as your designated medical-care coordinator.
Keep copies of your medical records. If you are prescribed medications by more than one health-care provider or through more than one physician network, keep a folder of your medical information and take it to all appointments. If a provider isn’t up to speed, you can quickly share important facts on tests, treatments and more.
What to keep in the folder: a current list of your medications and supplements, and facts about any allergies, major illnesses, hospitalizations and surgeries you’ve had. If possible, double-check your doctor’s patient portal after visits to make sure your information is correct.
Get and share test results. When Avitzur’s patients don’t get the results of medical tests quickly, they often assume all is fine. Don’t make that error. Every doctor’s office has had organizational systems fail. In fact, in a 2013 study, almost a third of PCPs reported having personally missed test results that led to delays in care.
So when you have a test or procedure, ask when you can expect results. If you’ve heard nothing within the expected time, call the office. If you can’t access results online, request a hard copy of the report and add it to your health folder. And ask that your PCP and other doctors — as needed — receive the results, too.
Know when communication is most critical. At hospital discharge, patients are especially vulnerable to adverse drug events, misunderstandings about care instructions and preventable readmissions. That’s why you should have a clear discharge plan, which notes which medications to continue and discontinue; when and with whom to schedule your follow-up visits; how wound or incision dressings will be cared for at home; and when a catheter needs to be removed. That information should be relayed to you and family members before you leave the hospital and to your PCP (who may not be in charge of your care while you’re hospitalized) and specialists in as timely a manner as possible.
For further guidance, go to www.ConsumerReports.org/Health, where more detailed information, including CR’s ratings of prescription drugs, treatments, hospitals and healthy-living products, is available to subscribers.