A new specialty in medicine is that of the hospitalists. These are physicians who follow patients in the hospital before they are discharged. Kripalani and coworkers noted that the period following discharge from the hospital is a vulnerable time for patients. For example, about half of adults experience a medical error after hospital discharge, and 19%-23% suffer an adverse event, most commonly an adverse drug event. The authors described several challenges to providing high-quality care as patients leave the hospital. These include the lack of agreement between hospitalists and primary care physicians, changes to the medication regimen, new self-care responsibilities that may stress available resources, and complex discharge instructions. Approaches to promoting more effective transitions of care, including improvements in communication between inpatient and outpatient physicians, effective reconciliation of prescribed medication regimens, adequate education of patients about medication use, closer medical follow-up, engagement with social support systems, and greater clarity in physician-patient communication were discussed.

VALUE OF STUDY TO READER: The authors concluded by saying that by understanding the key challenges and adopting strategies to improve patient care in the transition from hospital to home, hospitalists could significantly reduce medical errors in the post discharge period. They likely could excel at this role. What could be an especially important role for hospitalists to play, however, would be to insure that patients can effectively manage their condition upon discharge. Making the latter contingent upon successful self-management training would seem a promising way to reduce consequences of a chronic illness following discharge. Hospitalists could play a significant role here.

S Kripalani et al. Promoting effective transitions of care at hospital discharge: A review of key issues for hospitalists. Journal of Hospital Medicine, 2007;2:314-323.