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Journal Article > Commentary
Transitions of Care Consensus Policy Statement American College of Physicians-Society of General Internal Medicine-Society of Hospital Medicine-American Geriatrics Society-American College of Emergency Physicians-Society of Academic Emergency Medicine.
Snow V, Beck D, Budnitz T, et al. J Gen Intern Med. 2009;24:971-976.
This policy statement describes ten principles developed to address quality gaps in transitions of care between inpatient and outpatient settings. Recommendations include coordinating clinicians, having a transition record, standardizing communication formats, and using evidence-based metrics to monitor outcomes.
Journal Article > Study
Safety of telephone triage in general practitioner cooperatives: do triage nurses correctly estimate urgency?
Giesen P, Ferwerda R, Tijssen R, et al. Qual Saf Health Care. 2007;16:181-184.
Many health systems rely on telephone triage to determine the urgency with which a patient should be seen by a clinician. Prior research has demonstrated that errors in triage may lead to patient harm. In this study, standardized patients with a variety of symptoms contacted telephone triage nurses at four Dutch general practices. The investigators analyzed the accuracy of triage decisions by comparing the nurses' advice to the national guideline for telephone triage. Both underestimation and overestimation of the severity of patients' illnesses occurred, although errors were less frequent when nurses had received specific training in use of the guideline. A prior AHRQ WebM&M commentary discusses the potential pitfalls inherent to providing medical advice by telephone and strategies for minimizing patient harm in these situations.
Journal Article > Study
Sequist TD, Marshall R, Lampert S, Buechler EJ, Lee TH. Arch Intern Med. 2006;166:2237-2243.
Nearly 1 in 10 patients hospitalized for an acute myocardial infarction (AMI) in this cohort study had seen an outpatient physician within 30 days before the event but were not immediately referred for appropriate diagnostic testing, despite having symptoms concerning for AMI. Failure to use appropriate risk stratification methods such as the Framingham score may have accounted for these missed diagnoses.
Journal Article > Review
Coordinating care across diseases, settings, and clinicians: a key role for the generalist in practice.
Stille CJ, Jerant A, Bell D, Meltzer D, Elmore JG. Ann Intern Med. 2005;142:700-708.
This review examines the literature on coordination of care and its effectiveness to better understand how a generalist operates in an increasingly complex health care delivery system. The authors present six key recommendations. These include the need for greater evidence to substantiate the value of care coordination in improving health outcomes; a belief that a generalist's practice represents an effective hub for coordinating care in most patients; and that improved communication and coordination among generalists, specialists, patients, and their family members must be fostered. The authors advocate for greater emphasis on teamwork, increased education about effective communication and collaboration skills, and wider adoption and application of medical informatics.