JCI CORNER Communication is Essential to Continuity of Care
When seeking a medical procedure in another country, communication is key to having consistent, medically-appropriate, follow-up care. This communication should begin with the patient having a discussion with his primary care physician before the trip, and it should continue among the team of health care providers from both countries throughout the patient’s follow-up care.
If a health care team—which the patient should be a part of—isn’t communicating adequately, the patient will be at increased risk for complications and inadequate follow-up care. This is particularly true when the patient’s primary physician is not aware of nor involved with the patient’s choice to seek services in another country. The result could be great reluctance to provide follow-up care.
Physician-to-physician communication might sound simple, but it has challenges. Physicians throughout the world often do not speak the same native language, much less the language of health care. They might use different abbreviations and codes, and medicines may have different names in different countries. Therefore, a written record of the procedure and needed follow-up care, along with oral or written communication between the doctors, is advisable if possible.
Bringing your medical records along is not as simple a solution as it sounds, because a patient’s access to his medical records is also inconsistent around the world. Although the World Health Organization (WHO) advocates that every patient should be in charge of his medical information, this is not always the case. In part because of privacy and confidentiality laws and other concerns, in the United States a patient’s records are maintained by his providers and, depending on the provider, it may be challenging for the patient to obtain them. In China, the patient is usually the custodian of his outpatient records and hospitals typically turn them over to the patient following a visit. In some hospitals in Japan and other countries, patients have full access to all their health care information via an in-room video monitor as well as postdischarge access.
For a hospital to receive Joint Commission International (JCI) accreditation, it must meet a number of requirements related to communication and follow-up care. For example, the hospital must give each patient a detailed discharge summary including a list of medications the individual was prescribed on discharge, as well as those he was previously taking and must resume when he gets home.
The discharge summary is also to be provided directly or through the patient to the referring physician or the physician responsible for follow-up care. All written and oral communications with the patient must be in a language and a format the patient understands; the patient’s understanding is to be verified. The organization should also provide caregivers for patients who speak the same language or translators.
In addition, it is helpful if hospitals ensure that the physician providing follow-up care is aware of what was done to the patient and if there were any complications, recommended follow-up instructions, including when the patient needs to be seen by the physician, and anything abnormal. Hospitals should also list the brand names and generic names of prescribed medicines.
JCI recommends that the patient should also become an informed, active member of his health care team. He can assist the doctors by maintaining a list of all medicines he is taking and actually bring the medicines with him to the hospital. It is also recommended that patients bring an advocate to the hospital who can listen, ask questions, and observe the patient as he recovers.
As electronic medical records become more common and communication technologies improve in health care organizations around the world, communication among physicians becomes much easier. Many doctors can now communicate across the Internet and can provide a patient’s other physicians access to any electronic medical records. This allows all involved physicians to participate in the medical care provided, making communication continuous. These advances are good for communication, but most importantly, they enhance patient safety and quality of care.
Karen Timmons is President and CEO of Joint Commission International