A plan to improve group call coverage for nursing homes.

Medical coverage for a nursing home traditionally has been provided by a single physician. In that situation, whenever a patient has a problem that needs to be addressed, a nurse can count on discussing the case over the phone with a physician who knows and has seen the patient. However, sharing after hours calls among physicians is becoming increasingly prevalent. With more frequent corss-coverage, there is a greater likelihood that a physician who is not familiar with the usual status of a patient will be handling the problem.

Decisions concerning a patient in a nursing home often are based on the degree of departure from the baseline status of the patient. However, it is difficult for a physician who has not seen a patient to appreciate that baseline. Standard medical diagnoses and problem lists do not convey the information about baseline status. Furthermore, important data about a patient often are not retrievable from nursing home staff at the time of a patient problem. Part-time and floating nurses who also are not familiar with the patient frequently are unable to provide necessary information.

Alleviating that problem would result in improved care of nursing home patients. It also would decrease the frustration of both the physician and the nurse in discussing a patient's problem over the phone, when the physician is unfamilar with the patient. The article describes a portable data system for nursing home patients, which is available to each physician on call and which gives baseline functional data about each patient.

Methods

The physican faculty for the division of family practice at the University of Utah provides care for approximately 400 patients in seven nursing homes; and they they are medical directors of five of those homes. It is a six-physician group practice. The night call for the practice, including nursing home patients, rotates among all six physicians. Thus the probability is high that a problem that occurs after-hours or on weekend will be handled by someone other than the physician familar with the patient.

To overcome that difficulty, a patient information card was designed on a three- by-five -index card, with information on each nursing home patient.

The data on the card readily "paint a portrait" of the patient, including the patient's name, age, problem list, medical diagnoses, medications and allergies; and in addition, the card contains the reason for the patient being in the nursing home and information from assessment tools familar to practioners experienced in geriatric care.