Minding the Gap

A colleague of mine posed an interesting question earlier today about how outpatient providers and nurses can contribute to patient safety.  His comments conjured up something that I too have been mentally noodling since arriving here at the Telluride Experience.  I was instantly reminded of an interesting observation made by one of my clerkship directors right before starting an ambulatory internal medicine rotation, in which he drew a line of an individual’s health over the course of their lifetime. The primary take-away from this diagram was that a very small percentage of an average person’s “health timeline” is spent as a hospitalized patient. Fortunately, most people are healthy, and can manage there health as an outpatient. Does that mean they are not the victims of medical error? Probably not. Yet our discussions have not addressed this issue. In particular, our patients are at greatest risk for error leading to harm when they transition from one environment to the other.  Perhaps that’s a great starting point for innovation and improvement…

At one point we discussed the minimal avenues available to hospitalized patients and their families in terms of advocacy. True, some hospitals do have employees who fulfill this role, but often time these are strangers who must advocate without that advantage of a long relationship with the patient.  But what if we developed systems where patients who see a primary care physicians or mid-level providers (NP, PA, etc), used that provider as their advocate while in the hospital? We would have access to the person/team who knows them well, who can share key insight, and who also have the great benefit of being of a suitable “tribe” who can command the attention of the inpatient medical team. If it works it’s a win-win-win: the patient gets proper advocacy from people who actually know them, the inpatient team is privy to a level of insight they may not get otherwise, and the outpatient team knows about a serious medical event in their patient’s life.  Seems like a true model of “patient-centric care.”

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