According to a new study at the University of Colorado Anschutz Medical Campus, there are serious gaps in communication between physicians and home health providers — gaps that can significantly contribute to higher readmission rates as well as other problems with the delivery of care.
The research was led by Christine Jones, MD, MS, an assistant professor at the Colorado School of Medicine. Dr. Jones conducted six focus groups with home health nurses from agencies around Colorado, with the intent of learning more about their experiences taking care of patients after hospital discharge. While the nurses revealed a number of issues, by far the most common theme was a lack of communication and problems getting the information they need to provide quality care.
Communication Breakdowns
“I actually got in trouble for contacting the hospital . . . [and] trying to track a doctor down,” said one home health nurse in the study. Other nurses reported similar circumstances, finding it difficult to get in touch with physicians to get clarity on medication lists, discharge orders, or more information about a patient. Not only do they run into roadblocks when trying to actually reach a physician, lack access to patient records, and often have to deal with doctors who aren’t willing to take accountability for confusion or errors, but regulations and policies often make it difficult to get clarification. This all makes it difficult for HHAs when improving health care quality for patients after hospital stays.
For example, many nurses report reaching out to a patient’s primary care physician, only to discover that the PCP was entirely unaware of the patient’s hospitalization. Even more concerning is the fact that many patients, especially those who use community health clinics, have a nurse practitioner for their primary care provider. As nurse practitioners are unable to sign orders for home health, many patients saw an unfamiliar physician in order to get approval for services. Without an understanding of the patient’s entire medical history — including medication — an ordering physician may unintentionally create confusion for home health care providers, while also contributing to communication breakdowns.
Home health care advocates note that these communication gaps are especially concerning for many reasons. Not only do they contribute to readmissions, but also affect the ability of the HHA to provide the best quality care. And most importantly, the majority of patients receiving home health care are elderly, homebound, and dealing with multiple chronic conditions, making them some of the most vulnerable patients, and underscoring the need for seamless, accurate communication.
Fixing Communication Issues
Dr. Jones and her team of researchers note that the results of this study clearly indicate that hospitals and hospital-based providers need to improve discharge processes and provide better support to patients once they have left the hospital. Clearly, this means working more closely with home health providers, but there are some additional ways to improve communication that can be put into action immediately.
- Provide access to electronic medical records. Giving home health providers access to patients’ EMRs can help provide clarification and insight that will lead to better care.
- Integrate software solutions that improve communication. Secure home health software with communication portals allow providers, home health nurses, and patients or family caregivers to communicate securely.
- Provide direct telephone access to providers. When home health providers don’t have to spend time leaving messages or attempting to track down an ordering physician, questions are answered more quickly and patient care doesn’t suffer. It’s also important for hospitals and physicians to understand the importance of home health calls, and streamline communication to ensure those calls are answered and returned in a timely manner.
- Establish a more direct line of accountability for discharged patients. Dr. Jones’ team recommends establishing accountability for home health orders with the hospital physician until the patient is seen by his or her primary care physician. Once that visit takes place, the home health provider can direct questions or concerns to the PCP.
- Support changes in laws that will allow nurse practitioners to write orders for healthcare. Such a bill was proposed in the last session of Congress, but was not taken up.
Improving the communication between doctors and home health providers post-discharge needs to be a priority not only for patient safety, improving health care quality, and reducing hospital readmissions, but also for better meeting the goals set forth by CMS, and maintaining compliance with Conditions of Participation and CMS guidelines. By implementing tools to improve communication and setting agency policies and procedures to prioritize communication, you’ll be better positioned to avoid the serious communication gaps that put patients in danger and make it harder for your providers to do their jobs.
Complia Health offers a wide range of products and solutions that can help your agency not only communicate more efficiently, but also more effectively manage staff, comply with regulations, and meet goals. Check out our comprehensive resources here, and learn more about how our advanced software solutions can help your agency grow and improve.
