AMA Issues 5 Patient Safety Guidelines

The American Medical Association has outlined five key responsibilities physicians should adopt when providing care for patients recently discharged from the hospital.

The recommendations listed in the report were developed to improve safety and reduce hospital readmissions for patients returning home, according to the AMA Center for Patient Safety, which is attempting to build a bridge between inpatient and outpatient settings.

With the new guidelines, The Center for Patient Care study says it hopes to break a historic trend that left the responsibility for transition plans almost solely in the hands of the inpatient clinical teams.

"There has been relatively little attention paid to exploring specific roles and responsibilities for outpatient clinics and other ambulatory practices during care transitions," the study says.

"But one thing we know is that patients leaving the hospital too often return to ambulatory care settings that are not well connected to the hospital team and this can result in inefficient, confusing and sometimes unsafe conditions."

"Inpatient teams face important limitations in ensuring safe transitions to ambulatory settings," the report continues. "Given the great variability of inpatient and ambulatory care team resources and capabilities, there can be no 'one-size fits all' model for safe care transitions; but certain tasks during care transitions are probably best carried out by members of the ambulatory rather than the inpatient care team, since the ambulatory practice will be responsible for providing ongoing care to the patient in the ambulatory setting."

The five responsibilities outlined in the report include:

1. Assessment of the patient's health;
2. Goal-setting to determine desired outcomes;
3. Supporting self-management to ensure access to resources the patient may need;
4. Medication management to oversee needed prescriptions;
5. Care coordination to bring together all members of the health care team.

The report was issued this month shortly after Medicare announced that it will accept the newly created Current Procedural Terminology codes for care coordination to pay physicians for the management of patients who have recently been discharged from a hospital or skilled nursing facility, the AMA said.

The AMA's CPT Editorial Panel built the codes to catalog care management services, including time spent talking about a care plan, connecting patients to community services, transitioning them from inpatient settings and preventing readmissions.

Improving care coordination and transitions is expected to become more important in the coming years, the report says, "as new models of care delivery, improved methods of communication, and changes in payment systems will each propel an emphasis on understanding optimal roles for ambulatory practices in supporting safe care transitions for patients entering and leaving hospitals and other inpatient facilities."

"When a patient leaves the hospital to go home, they are transitioning back into the care of their outpatient primary care and specialty physicians,"

AMA President Jeremy Lazarus, MD, said in prepared remarks issued with the report that care coordination between inpatient and outpatient physicians is critical to ensure success.

"Physicians in ambulatory care settings must first have access to information about their patients' hospital stays to ensure continuous, high quality care," Lazarus said. "The lists of actions recommended in this report can then serve as a guide as physicians care for recovering patients."