EDITORIAL

Just today I got an e-mail from a friend who suffers with rheumatoid arthritis. She wrote: I hate people named Pete…and my rheumatologist’s office has a nurse named Pete. He is also a bully. I have been having trouble getting my Plaquenil prescription refilled. So I call my rheumatologist’s office. They say they haven’t gotten an eye exam report on me for three, almost four years (required annually for this prescription). I explained I had one last August, one in June 07, and one in July 06. They say the last one they see in the system is for 05. Then they asked why I hadn’t called earlier to resolve this. I tell them I have been calling three or four times a year for the past two years, both their office and that of my ophthalmologist…and maybe they should be talking to each other. Peter, the nurse says, no, that is your responsibility. I say, oh it is my responsibility to coordinate your medical system? So, Pete puts their office manager on and we go through the same conversation. This conversation also deteriorates –sigh! I ask her to please give me the name of her superior to take it up with them, including whose responsibility it is to find this information, especially since I don’t have access to the system. And voila…all of a sudden, she finds the information, and realizes that they have been looking at the wrong ophthalmologist for reports and oh aren’t they just so sorry. I have my prescription and have another year until I will probably again have to deal with Pete.

My friend is scrappy – she’ll get the issue resolved however challenging. But many patients are not like that. Instead, they get lost in the system, or get pushed around by care givers. Many duplicate diagnostic tests to make up for a lack of communication between providers. Some get handed off (i.e., transitioned) from one provider to the next without anyone explaining what diagnostic procedures or treatments have already happened, or without adequate information about prescriptions. Is there any surprise errors happen? Not to mention the unease, confusion, and anger that accompanies these situations. My friend’s note reveals an example of a serious problem we face in healthcare, a problem that drives up costs, pain, and death, a problem that is completely preventable. Transitions of care, the hand-off of the patient from one provider to the next, is the focus of this issue of Frontiers. As Dr. Eric Coleman of the University of Colorado Hospitals, says, “discharge out of the hospital is a time of heightened vulnerability for our patients.” This is a point at which there is, as Maureen Bisognano from the Institute for Healthcare Improvement suggests, great opportunity for improvement in the quality of care that we deliver. This issue’s commentators provide additional insight into this situation. Key moments of transition occur in many fields – sports, air travel, security, and others. We have opportunity to learn from these other fields; many hospitals have, in fact, developed procedures based on the checklist pilots use prior to take off. Consider the downing of US Airways Flight 1549 earlier this year. Spontaneous coordination and clear communication among air traffic control, the Coast Guard and ferries and, of course, “Sully” and his crew, prevented the loss of a single passenger or crew member. All of us who travel would hope for such an outcome were we in that situation. And when we become hospital patients, we certainly hope that our providers, like Sully and his team, communicate among themselves and with us to give us the best chance for a positive outcome. Our lives depend on it – our stress levels need it.