On Sun, 2004-11-21 at 06:19, Elkin, Peter L., M.D. wrote: > At Mayo Episodes of care start with any billable encounter with > the health system (e.g. clinician visit, lab test, etc.) and ends > when the clinician of primary record says that the episode is complete. > For curable illness this often occurs after the cure. For chronic > illnesses it usually ends when the patient reaches a steady state or > a goal (e.g. Diabetes Mellitus with a HgA1C < 7.0 mg/dl). For > surgeries it may be after the first post hospital visit. For medical > hospitalizations it is often at the time of discharge. This has two > important implications. One there is one clinician who is identified > as the team leader of record who is charged to coordinate all of the > care from any provider in the health system.
That is quite different to the model of care in Australian hospitals (and British hospitals when I worked there 20 yrs ago - probably still the same). Patients are the responsibility of "teams" (or "firms") organised around a consultant/specialist (or a small group of them). Thus, if a surgical patient is admitted to ICU post-surgery, then it is the ICU team (and ultimately the ICU specialist in charge) who has the final say in the patient's care (well, the patient and relatives may have some say...) while they are in the ICU. The surgical team might drop by to see how the patient is going and to assess te outcome of the surgery, but the surgeon doesn't manage, for example, the haemodynamics, ventilation and blood sugars of the patient. Responsibility for recording what happens falls to the teams currently in charge of the patient. > Two, at the end of an > episode the clinician is mandated to sum up the episode and state for > the record what are the final diagnoses for this episode of care. The defect in the Australian model is that the responsibility for this summing up falls to the last team to look after the patient prior to separation - and that team may not be very interested or knowledgeable about the treatment which went on before they took over the patient (although it would be rare or unfortunate if they did not know enough to record some sort of precis of it). However, as a GP, I often used to receive hospital discharge summaries which devoted one line to the extensive surgery which a patient underwent and the weeks which they spent in ICU recovering from complications, but half a page to their rehabilitation and functional status at discharge. Of course that is quite appropriate for a discharge summary, and perhaps for a community-based EHR. Less useful if some other surgeon in some other hospital needs to revisit the patient's earlier surgery (but surgeons prefer to look for themselves and never believe anything written in the medical record - or EHR). Tim C - If you have any questions about using this list, please send a message to d.lloyd at openehr.org
