‘Warm handoff’ needed between ER and physician office


The patient-centered medical home where Fred N. Pelzman, M.D., works has done a good job improving communication when a patient is sent from the medical practice to the emergency room, he says.

Now it’s time to improve communication in the other direction: from the ER to the physician’s office, writes Pelzman, of Weill Cornell Internal Medicine Associates, in a piece for MedPage Today.

The academic medical practice is now working to create a patient-centered strategy to better serve patients who have been treated in the emergency department or hospital, he says. For instance, the practice has set up rapid discharge access appointments that allow the emergency room to put the practice’s patients directly on its schedule if they need follow-up the next day, within three days or within seven days.

But what’s really needed is what Pelzman calls a ‘warm handoff’ of the patient back to the medical practice. While doctors receive an electronic copy of the discharge summary, what might be more valuable is a conversation between the emergency room and someone at the practice to decide what the best plan is for the patient, he says.

Some organizations now rely on patient navigators to make this happen. For instance, Virginia Feldman, M.D., an ENT surgeon who had admitting privileges at Orange Regional Medical Center, helped develop a program that has care coordinators meet with patients and their family members within the first two days of hospital admission to explain the process and form a relationship with them. They also arrange to have their prescribed medication delivered at their bedside prior to their release from the hospital or directly to their homes and make follow-up appointments for the patients within five business days of discharge.

"We have the nurse on our care coordination team review the clinical signs and symptoms with the patient so they know the early warning signs [and] understand when they need to reach out to the appropriate doctor" to avoid readmissions, Feldman told FierceHealthcare during an interview last year.