Family physicians are participating on both sides of the new models of health care delivery, which utilize a dedicated inpatient physician (or "hospitalist") to manage the inpatient care of general adult medicine patients referred by primary care physicians in the community. The American Academy of Family Physicians (AAFP) believes that family physicians are well trained and highly qualified to serve in these roles, and that participation in such arrangements should be voluntary for both the referring physician and the patient involved.
Because "continuity of care" has been a hallmark of the specialty of family practice, the AAFP is especially concerned about safeguarding continuity in these new models through adequate communication. The following guidelines are intended to support quality care to patients and their families, and to clarify expectations for communication between physicians participating in such systems.
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Guidelines for Interaction in "Hospitalist" Models
Communication Between the Receiving Inpatient Care Management Physicians and the Referring Primary Care Physician
- The overarching objective for all should be the best possible care for the patient.
- At the request of the family physician (or other primary care physician), the inpatient care physician (who may also be a family physician) should admit and coordinate the care of all patients admitted to the hospital regardless of the admitting diagnosis or type of insurance coverage.
- If patients present to the emergency department (ED) and the ED physician assesses them, the ED physician should then contact the patient's family physician to determine if admission is necessary or if close follow up or outpatient work up is more appropriate.
- If admission is necessary, the family physician should communicate information on pre-hospital treatment, work up, co-morbidities and ongoing specialty consultations, along with family and social concerns, advance directives, etc., to the inpatient care physician who is assuming management of the patient's care.
- The inpatient care physician will assess the patient at admission and determine the best course of treatment. This may include treat and release, admit for general medical management or admit for medical or surgical subspecialty care, while providing general medical oversight.
- During the period of hospitalization, decisions regarding care, consultation, admission, transfer and discharge should be the sole responsibility of the inpatient care physician in consultation with the patient and, as appropriate, the patient's family physician and/or family members.
- The inpatient care physician should be readily available to discuss the patient's medical problems and hospital course with the family and should provide timely updates to the family physician designated by the patient. Communication with the family is extremely important at the time of any changes in the patient's status, complications or new diagnosis (e.g., cancer).
- The inpatient care physician should communicate the treatment plan and follow-up recommendations to the patient's family physician or the covering physician on the day of discharge.
- When family physicians refer their hospital patients to the care of an inpatient physician, the AAFP strongly encourages them to maintain ongoing communication with the patients and their families throughout the hospitalization. Family physicians should also provide written communication to the inpatient care physician after the first post-hospital visit at the office where there may be an educational benefit.
- Health care systems which utilize inpatient care management models should seek to constantly monitor and improve their processes through the use of ongoing surveys for patient and physician satisfaction with the system. Data on health care outcomes is essential to the ultimate evaluation of these models.
Hospitalists
Guidelines for Interaction
