February 9, 2011
Information gaps create risks during transitions of care
For your next medical appointment:
- Tell the scheduler the reason for your visit
- Take a list of your medications
- Bring records and test results, or a brief medical history
- Ask your doctor for an after-visit summary
These transitions can be as simple as seeing a specialist who works in the same clinic as your primary-care doctor or as complex as a discharge from a hospital to a rehabilitation center. They can also involve multiple “hand-offs.”
For example, the care for a person who has had a recent stroke could involve an emergency room, a hospital, a rehabilitation center and a long-term care facility.
In an ideal world, your medical history would be available instantly wherever you receive care. The reality is that communication during transitions from one setting to another is often poor and this poor communication can lead to errors. You need to work with your health care team to minimize information gaps. This will reduce the risk of confusion over treatment plans, duplicative tests, medication errors and other problems related to transition of care.
Clinic visits. An accurate exchange of information begins when you make your appointment. Let the scheduler know if you are coming in for an acute issue, a chronic condition or a wellness exam. If you need follow-up care after being treated in an emergency room or another health care setting, let the scheduler know so that your records can be requested prior to the visit.
Medical history. When you see a health care professional for the first time, bring copies of your medical records and lab results if they are available. Otherwise, you can prepare your own medical history by listing your current problems, chronic conditions, current medications (prescription, over-the-counter and herbal), known allergies, immunization record and past surgeries. Include the reason for each surgery for future reference. For example, knowing whether a woman had a hysterectomy because of bleeding, fibroids or cancer will be important if she experiences lower pelvic pain later in life.
Medications. Keep the names and doses of medication with you at all times and know why you are taking them. Atenolol, for example, can be used to treat blood pressure or migraines. You should also know how long you are supposed to take the medication. After a heart procedure, Plavix will generally be prescribed for six months. After a stroke, it may be used lifelong. Check for prescription errors and drug interactions by reviewing your medications during a clinic visit. If possible, bring all of your medicines, vitamins, minerals and herbal supplements in their original bottles. You should also prepare a medication list that includes the drug name, what it looks like, when you take it, your dosage, why you take it and who prescribed it. For a printable form, go to “My Medicine List” on the website of the National Transitions of Care Coalition.
After-visit summary. At the end of each clinic visit, I give my patients a written summary that includes vital signs, procedures performed, care instructions and a current medication list. If I have ordered additional tests, I provide the detailed results when available — either through a secure web connection or in a letter sent to their home — for further discussion.
Advance directives. Documents such as a living will and a “durable power of attorney for medical affairs” are important in helping others provide appropriate care for you at the end of your life. However, those forms are often long and complicated. As an alternative, patients are encouraged to complete a simple two-page form created by the Washington State Department of Health and Washington State Medical Association. The Physician Orders for Life-Sustaining Treatment (POLST) consists of check boxes with treatment options for cardiopulmonary resuscitation (CPR) and medical interventions such as antibiotics and feeding tubes. It must be signed by a physician, physician assistant or advanced registered nurse practitioner after a discussion with the patient to assure that the choices are fully understood. Health care professionals are obligated to provide full treatment in the absence of any of the above documents.
Keep a copy of the POLST form in your wallet or purse so that it is available in case of a medical emergency. You should also post it at home to help family members understand and become comfortable with your wishes regarding these personal choices for life-sustaining treatments. For more information, visit the Department of Health website.
Yaquta Patni, M.D., is a board-certified family medicine and geriatric medicine doctor at the UW Medicine Neighborhood Clinic in Shoreline. For more information, call (800) 852-8546 or visit www.uwmedicine.org/uwpn.