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Research News: Making Hospital Discharges Safer for Seniors
Debra: Elderly patients just returning home from the hospital are prone
to medication mishaps. With the help of an AHRQ grant, Dr. Jerry Gurwitz, Chief
of Geriatric Medicine at the University of Massachusetts Medical School, has
developed an information technology system to make the transition from hospital
to home safer. Welcome, Dr. Gurwitz.
Dr. Gurwitz: Thank you.
Debra: Why is the post-discharge period so dangerous for older people?
Dr. Gurwitz: That’s a good question. Most seniors suffer from multiple
medical problems, including heart disease, hypertension, diabetes and many
others, and they’re often taking several medications when they’re admitted to
the hospital and even more after discharge. So during their visit with their
primary care physician after discharge, a physician must review a whole list of
medications and check for safety problems and side effects. Sometimes the doctor
doesn’t receive all the crucial information that’s required, and when this
happens, errors or injuries to patients can occur.
Debra: Why doesn’t the primary care doctor always get the information?
Dr. Gurwitz: Traditionally, the doctor taking care of the patient in the
hospital writes a discharge summary and gives a hand-written report to the
patient. Or the hospital sends a report to the primary care physician, often by
fax or regular mail. In many cases, the discharge summary doesn’t arrive on time
or it may even be lost in transit. And either way, the primary care physician
doesn’t always have all the information that he or she needs to treat the
patient properly.
Debra: So, when this happens, what kinds of things can go wrong?
Dr. Gurwitz: Well, the primary care physician might not realize that a
patient has been started on a new drug and might not order a test to determine
if the drug is being dosed appropriately. Without this safety check, serious
complications can occur that can cause harm to patients.
Debra: And how can information technology help?
Dr. Gurwitz: Interestingly, what we are doing is using an existing
electronic medical record system, which now includes a written electronic
summary that can be accessed by the primary care physician in the office
setting. And that discharge summary includes a list of medications, including
new ones added in the hospital. It also includes clear instructions to order
follow-up lab tests if there is a danger of a drug-related complication. So the
primary care doc has access to this information before the patient’s next visit.
Debra: How will this system prevent drug-related injuries?
Dr. Gurwitz: We believe this system will provide the primary care
physician with timely information that can be used to prevent drug-related
complications. The real hope is that this system will avoid preventable and
costly problems for the patient.
Debra: How will you test the IT system?
Dr. Gurwitz: We plan to test the system with seniors cared for at the
Fallon Clinic. The Fallon Clinic is a medical group in Central Massachusetts,
and all of these patients are enrolled in the Senior Plan of the Fallon
Community Health Plan. Fallon Clinic already has an electronic medical record
system in place, and we’re adding onto that system. In the future, we envision
that other facilities might be able to use this system. But hospitals or clinics
that don’t have an existing IT system would have to implement an electronic
medical record system before adding on such a program.
Debra: Dr. Gurwitz, thank you for joining us. To learn more about this
project and other Health IT tools and resources, visit the Web site:
healthit.ahrq.gov.
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