Home From The Editor Is a ward-based clinic the answer for high-risk patients?

Is a ward-based clinic the answer for high-risk patients?

July 2005

Published in the July 2005 issue of Today’s Hospitalist.

How much do you know about what happens to your patients after they leave the hospital?

We get at that question in this month’s issue by looking at recent research on adverse drug events that affect patients after discharge. While the study concludes that physicians may be able to prevent or minimize common drug problems (GI complications of anti-infectives, for example), it doesn’t address more serious challenges, like the congestive heart failure patient with renal dysfunction.

As it turns out, the lead author of the study is experimenting with a way to address exactly that situation. While the solution may be unusual for hospitalists, it makes perfect sense: Ask certain high-risk patients to come back to the hospital for a follow-up visit.

The hospitalist service at this hospital set up a small exam room where physicians can examine high-risk patients a few days after discharge. While some hospitalists were wary about the clinic when it was first introduced, many now seem to enjoy it.

The hospitalists have no desire to try their hand at primary care, but the clinic does give them a nice change of pace. More importantly, it gives high-risk patients the continuity of care that is so important in managing critical illness.

In some ways, this type of clinic goes against the grain of hospital medicine. Hospitalists are supposed to return patients to their primary care doctors after discharge, not continue to treat them in the wards. As the specialty matures, though, hospitalists are realizing that it doesn’t always make sense to simply discharge patients and forget about them, particularly when they’re trying to manage multiple signifi cant diseases.

Is this ward-based clinic the future of hospital medicine? I don’t know. It does, however, shine a light on ways to look out for those patients who need a little extra care.

Edward Doyle
Editor and Publisher