The Medical clinics of North America
-
This study demonstrates many of the important features and challenges of improving hospital care. The unique confluence of software technology advances and increasingly complex clinical needs have made possible a redesign of the process by which discharge documentation is generated and disseminated. Using knowledge of the patients' experience of hospital care, a multidisciplinary team identified communication at the time of discharge as a key interaction point in the system of care. ⋯ Will the quality of care improve? Probably, although that remains to be seen. Improvements in care do not need to be sophisticated, they do not need to be elaborate, and they do not need to involve new devices or new technologies. Improvements start with thinking about the way work is done and reflecting on how the work might be done differently to meet and exceed patients' needs and expectations.
-
The majority of Americans die in hospitals where shortcomings in end-of-life care are endemic. Too often, patients die alone, in pain, their wishes unheeded by their physicians. Because hospitalists care for many of these dying patients, they can dramatically improve end-of-life care in hospitals. ⋯ In addition, they should communicate clearly with patients and families, and provide them psychosocial support. Hospitalists can increase the number and the timeliness of hospice referrals, thereby allowing more patients to die at home. Finally, all physicians must attend to their own senses of grief and loss to avoid burnout and to continue to reap the rewards end-of-life care provides.
-
The hospitalized surgical patient requires a team approach. Because of increasing patient age and complexity of conditions, a comprehensive preoperative evaluation and medical optimization is often necessary to allow the anesthesiologist and surgeon to deliver the best surgical outcome. ⋯ Special surgical populations, such as those patients who need perioperative anticoagulation, further benefit from a surgical team that includes a medical specialist. Expertise and close supervision throughout the perioperative period will give the hospitalized surgical patient the greatest chance for a quick and successful recovery.