Problems after discharge and understanding of communication with their primary care physicians among hospitalized seniors: a mixed methods study.

BACKGROUND: Communication and coordination with primary care physicians (PCPs) is recommended to ensure safe care transitions for hospitalized older patients. Understanding patient experiences of problems after discharge can help clinical teams design more patient-centered care transitions. OBJECTIVE: To report older patients' experiences with problems after hospital discharge and investigate whether PCPs were aware of their hospitalization. DESIGN: Prospective mixed methods study. SETTING: Single academic medical center. PATIENTS: Hospitalized patients and PCPs. MEASUREMENTS: Telephone interviews of frail, older general medical patients conducted 2 weeks after discharge to elicit patient problems after discharge, such as: (1) obtaining medications, or follow-up appointments; and (2) perceptions of hospital physician communication with their PCP. For each patient interviewed, their PCP was faxed a survey 2 weeks after discharge to assess awareness of hospitalization. RESULTS: Forty-two percent (27) of patients reported 42 different post-discharge problems. The most frequently reported problems were difficulty with follow-up appointments or tests (12). Other reported problems included readmission and return to the Emergency Department (10), problems with medications (8), not-prepared for discharge (8), and hospital complications or questions (4). Thirty percent of PCPs were unaware of patient hospitalization. Patients were twice as likely to report a problem if their PCP was unaware of the hospitalization (31% PCP aware, vs. 67% PCP not aware; P < 0.05). CONCLUSION: This study suggests that many frail, older patients reported problems after discharge and were twice as likely to do so when the patient's PCP was not aware of the hospitalization. Systematic interventions to improve communication with PCPs during patient hospitalization are needed.

Interns overestimate the effectiveness of their hand-off communication.

OBJECTIVE: Theories from the psychology of communication may be applicable in understanding why hand-off communication is inherently problematic. The purpose of this study was to assess whether postcall pediatric interns can correctly estimate the patient care information and rationale received by on-call interns during hand-off communication. METHODS: Pediatric interns at the University of Chicago were interviewed about the hand-off. Postcall interns were asked to predict what on-call interns would report as the important pieces of information communicated during the hand-off about each patient, with accompanying rationale. Postcall interns also guessed on-call interns' rating of how well the hand-offs went. Then, on-call interns were asked to list the most important pieces of information for each patient that postcall interns communicated during the hand-off, with accompanying rationale. On-call interns also rated how well the hand-offs went. Interns had access to written hand-offs during the interviews. RESULTS: We conducted 52 interviews, which constituted 59% of eligible interviews. Seventy-two patients were discussed. The most important piece of information about a patient was not successfully communicated 60% of the time, despite the postcall intern's believing that it was communicated. Postcall and on-call interns did not agree on the rationales provided for 60% of items. In addition, an item was more likely to be effectively communicated when it was a to-do item (65%) or an item related to anticipatory guidance (69%) compared with a knowledge item (38%). Despite the lack of agreement on content and rationale of information communicated during hand-offs, peer ratings of hand-off quality were high. CONCLUSIONS: Pediatric interns overestimated the effectiveness of their hand-off communication. Theories from communication psychology suggest that miscommunication is caused by egocentric thought processes and a tendency for the speaker to overestimate the receiver's understanding. This study demonstrates that systematic causes of miscommunication may play a role in hand-off quality.

Improving inpatients' identification of their doctors: use of FACE cards.

BACKGROUND: Improving patients' ability to identify their inpatient physicians and understand their roles is vital to safe patient care. Picture cards were designed to facilitate physician introductions. The effect of Feedback Care and Evaluation (FACE) cards on patients' ability to correctly identify their inpatient physicians and on patients understanding of physicians roles was assessed. METHODS: In October 2006, team members introduced themselves with FACE cards, which included a photo and an explanation of their roles. During an inpatient interview, research assistants asked patients to name their inpatient physicians and trainees and to rate their understanding of their physicians' roles. RESULTS: Of 2,100 eligible patients, 1,686 (80%) patients participated in the baseline period, and 857 (67%) of the 1,278 patients in the intervention period participated in the evaluation. With the FACE intervention, patients were significantly more likely to correctly identify at least one inpatient physician (attending, resident, or intern; baseline 12.5% versus intervention 21.1%; p < .001). Of the 181 patients who were able to correctly identify at least one inpatient physician in the intervention period, research assistants noted that 59% (107) had FACE cards visible in their rooms. Surprisingly, fewer patients rated their understanding of their physicians' roles as excellent or very good in the intervention period (45.6%) compared with the baseline period (55.3%; p < .001). DISCUSSION: Although FACE cards improved patients ability to identify their inpatient physicians, many patients still could not identify their inpatient doctors. FACE cards may have served as a reminder to physicians to introduce themselves to their patients. The FACE cards also served to highlight patients' misunderstanding of their physicians' roles.

A new method in accelerating PROPELLER MRI.

In this work, a new method has been proposed to accelerate the PROPELLER MRI operation. The proposed method uses a rotary phased array coil and a new method in acquiring the k-space strips and preparing the complete k-space trajectories data set. It is numerically shown that for a 12 strips PROPELLER MR brain imaging sequence, the operation time can be reduced by four folds, with no apparent loss in the image quality.

Decoherence as a probe of coherent quantum dynamics.

The effect of decoherence, induced by spontaneous emission, on the dynamics of cold atoms periodically kicked by an optical lattice is experimentally and theoretically studied. Ideally, the mean energy growth is essentially unaffected by weak decoherence, but the resonant momentum distributions are fundamentally altered. It is shown that experiments are inevitably sensitive to certain nontrivial features of these distributions, in a way that explains the puzzle of the observed enhancement of resonances by decoherence [Phys. Rev. Lett. 87, 074102 (2001)]. This clarifies both the nature of the coherent evolution, and the way in which decoherence disrupts it.