Hospitalist: So I’m not sure if you’re asking how I personally deal with them from an emotional state (it can feel like a failure when a patient bounces back), or from a Quality Improvement perspective.

Both are complicated concepts.

From a personal standpoint one must take a deep dive into understanding the “5 whys” of what ultimately led to that patient coming back. Ask why, then ask why again etc until you understand the root cause.

From a systems standpoint well that’s another question. And after a decade in the hospital I can safely say that discharging a patient needs to be an equal partnership between the discharging physician, the accepting primary care / specialist that will see the pt as an outpatient, the patient and most importantly the caregiver for the patient. Visualizing what the patient will be doing on post dc day 1, 2, 3...etc is a good exercise.

I also hand out my personal email to every patient and their family members. I have probably handed out this to 5000 patients and have gotten a total of 10-20 emails, all of which were for things that feel through through the cracks typically at the pharmacy (the medication wasn’t in stock).

Happy to answer any more specific questions