Communication Between Primary Physicians and Staff of Long‐Term Care Facilities; <i>To the Editor</i> :

Abstract

To the Editor:—— We would like to comment on and share our approaches toward procedures for enhancing communication in long-term care facilities that were addressed in two recent letters to the editor.1,2 Dr. Rezvan's letter1 addresses an issue of critical importance to nursing staff, nurse practitioners, physicians’ assistants, and primary medical staff of long-term care facilities—when to call the doctor. Frequent phone calls, especially those unrelated to a significant change in a resident's status, are a nuisance for primary physicians and a waste of time for nursing home staff. On the other hand, nursing staff must have access to primary physicians when significant events do occur. Similar to Dr. Rezvan, we have developed a policy to address this situation, which we would also like to share with readers of JAGS (the policy is shown below). It differs from Dr. Rezvan's in that it is more specific about when to contact the physician for significant clinical events, and focuses less on what we would consider standard administrative issues. Our policy was developed through a joint review process between the nursing and medical departments. In implementing the policy, our director of nursing and nurse practitioners held in-service sessions with licensed nursing staff, and the policy was printed on file cards that have been made available at each nursing station for ongoing guidance. The critical feature of this policy is the distinction between what needs to be communicated to the physician immediately, versus what might be important but can wait until the next time the physician is in the facility (our physicians are usually in the facility once a week). This policy has greatly diminished the number of unnecessary calls to primary physicians and given the nursing staff much needed access to the primary physicians and confidence that their calls will be responded to appropriately. As a result the communication between our nursing and medical staff has improved substantially. We also think that the “Extended Care Transfer Record form” shared by Dr. Goff2 is an excellent idea. We have developed two similar forms that we feel have greatly simplified the transfer of our residents back from the acute hospital and improved the communication and documentation by our primary physicians. One form serves as a brief summary of the hospital admission (in lieu of dictated discharge summaries, which generally take several days to receive), and at the same time meets requirements for an admission summary to the nursing home. The second form is preprinted Physician Orders with enough copies so that retranscribing is unnecessary. Like Dr. Goff, we have made these forms available at our acute hospital, and required their completion at the time of discharge. Copies of these forms are available from us. We hope the approaches shared by Drs. Rezvan, Goff, ourselves, as well as others3 will be used more widely in nursing homes across the country. They should result in substantial improvements in the efficiency and quality of health care provided in this setting.