list: facility and physician who will follow.
Designating the physician who will be following the patient is critical information that directs the flow of future information. Unless you plan to be the patient's physician at the facility then designating the future physician must be done. Along with this designation comes the responsibility of the hospital physician to provide good transition information, including; sending copies of critical data from the hospitalization with the patient. (Suggested to send; H&P, labs, x-rays, consults and sometimes necessary to send the last three days progress notes) that will provide the receiving physician immediate information. Also promptly dictating the discharge summary, and remembering to send a copy of the discharge summary both to the facility or home health agency and the receiving physician. (Recognize, most discharge summaries will not arrive for 7-10 day unless you have done them in advance of the discharge).
Lastly when to call the receiving health care provider? Some guidelines include transfers, which:
a. something needs to be acted on right away, (example; a heart failure patient that needs close monitoring to prevent decline and readmission)
b. there is something controversial that needs to be explained (example; a family dispute over a patients advanced directives)
c. there is potential for greater than usual communication break down using the usual information flow. (example: a previous error in communication with your last admission to this particular facility)
d. make you nervous to discharge (example; if you realize the patient needs to be transferred, but you are quite nervous about their success at the next level, call the receiving HCP and discuss it, you will sleep better at night)