Published in the May 2011 issue of Today's Hospitalist
There's no doubt that important patient-care issues can fall through the big crack between hospital discharge and outpatient follow-up. ("Making a dent in readmissions," March. It's also true that we can improve the discharge process to reduce those incidents.
But I wish somebody would acknowledge that some patients are going to be readmitted despite our best efforts, and that patients who are poor are at the top of that list. In my county—Harris County, which includes Houston—public clinics are so overcrowded that patients who want to be seen after discharge have to first file an application. In a few weeks, that application is followed by an interview in which patients have to present documents proving how poor they really are.
Our social workers help them fill out and fax the application, and family members promise to provide transportation. But so much time will still pass before that first follow-up visit that people run out of meds (or sell them on the street). Go to a primary care physician's office? Only if the hospital offers to pay for the visit—and then how long will that relationship last?
A little realism on our part will prevent us from being crucified in the media a year from now when it turns out that some patients still aren't getting outpatient care within three months of being discharged. Hospitalists who take call for their ED and who treat unassigned patients need to be sure that the people who do our performance reviews know that there are some important goals that we just don't have the capability to reach.