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Wednesday, June 03, 2009 9:00 AM
Research News: Making Hospital Discharges Safer for Seniors

Debra: Elderly patients just returning home from the hospital are prone to medication mishaps. With the help of an AHRQ grant, Dr. Jerry Gurwitz, Chief of Geriatric Medicine at the University of Massachusetts Medical School, has developed an information technology system to make the transition from hospital to home safer. Welcome, Dr. Gurwitz.

Dr. Gurwitz: Thank you.

Debra: Why is the post-discharge period so dangerous for older people?

Dr. Gurwitz: That’s a good question. Most seniors suffer from multiple medical problems, including heart disease, hypertension, diabetes and many others, and they’re often taking several medications when they’re admitted to the hospital and even more after discharge. So during their visit with their primary care physician after discharge, a physician must review a whole list of medications and check for safety problems and side effects. Sometimes the doctor doesn’t receive all the crucial information that’s required, and when this happens, errors or injuries to patients can occur.

Debra: Why doesn’t the primary care doctor always get the information?

Dr. Gurwitz: Traditionally, the doctor taking care of the patient in the hospital writes a discharge summary and gives a hand-written report to the patient. Or the hospital sends a report to the primary care physician, often by fax or regular mail. In many cases, the discharge summary doesn’t arrive on time or it may even be lost in transit. And either way, the primary care physician doesn’t always have all the information that he or she needs to treat the patient properly.

Debra: So, when this happens, what kinds of things can go wrong?

Dr. Gurwitz: Well, the primary care physician might not realize that a patient has been started on a new drug and might not order a test to determine if the drug is being dosed appropriately. Without this safety check, serious complications can occur that can cause harm to patients.

Debra: And how can information technology help?

Dr. Gurwitz: Interestingly, what we are doing is using an existing electronic medical record system, which now includes a written electronic summary that can be accessed by the primary care physician in the office setting. And that discharge summary includes a list of medications, including new ones added in the hospital. It also includes clear instructions to order follow-up lab tests if there is a danger of a drug-related complication. So the primary care doc has access to this information before the patient’s next visit.

Debra: How will this system prevent drug-related injuries?

Dr. Gurwitz: We believe this system will provide the primary care physician with timely information that can be used to prevent drug-related complications. The real hope is that this system will avoid preventable and costly problems for the patient.

Debra: How will you test the IT system?

Dr. Gurwitz: We plan to test the system with seniors cared for at the Fallon Clinic. The Fallon Clinic is a medical group in Central Massachusetts, and all of these patients are enrolled in the Senior Plan of the Fallon Community Health Plan. Fallon Clinic already has an electronic medical record system in place, and we’re adding onto that system. In the future, we envision that other facilities might be able to use this system. But hospitals or clinics that don’t have an existing IT system would have to implement an electronic medical record system before adding on such a program.

Debra: Dr. Gurwitz, thank you for joining us. To learn more about this project and other Health IT tools and resources, visit the Web site: healthit.ahrq.gov.

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