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Karen Loftus (Host): This is Community Connect: presented by Tampa General Hospital. I'm Karen Loftus. Joining me is Dr. Mandy Dailey, Assistant Professor in the Department of Family Medicine at USF, and the Medical Director of Quality and Population Health at USF Health, and Christine Hutchinson, Director of Quality, Patient Safety, and Population Health at USF TGP. Welcome to the podcast, Dr. Dailey and Christine.
Dr. Mandy Dailey: Thank you so much. Thanks for having us.
Host: We're talking about the intersection of a hospital stay and follow-up care with a primary care physician, and making sure people know the best way to go about this. Many times, it's not just leaving the hospital and that's that. How do these pieces fit together, Dr. Dailey? And what role do primary care providers play during the transition from the hospital to their home?
Dr. Mandy Dailey: I think it's really important to remember that your primary care doctor is taking care of all of your healthcare needs, right? Like, we really are facilitating that from all sides. Whether you are just coming out of the hospital and had, you know, maybe it was an injury or it was a severe illness or something like that, or an exacerbation of your chronic medical problem, we really are very well equipped in our clinical knowledge and in our experience to be able to help you transition out of the hospital and back into ambulatory care. And ambulatory care is really, like, any care that's outside of the hospital.
Christine Hutchinson: Yeah, and I like to think of the hospital as sort of the emergency repair shop, and your primary care doctor is the mechanic who helps keep that engine going after you've gotten out of a repair shop.
Host: Oh, I like that. Okay.
Dr. Mandy Dailey: Yeah, I think that's a great analogy, yeah, of people becoming cars and, like, us taking care of everything. It's a mechanic who can actually take a look at everything. It's not an engine mechanic, right? It's not a gas pump mechanic. We can really do all of it.
Host: Okay. So, why can the period after leaving the hospital be challenging for some patients and families, Christine?
Christine Hutchinson: Yeah. It's really hard for patients, and I think sometimes they don't really realize the impact of a hospital stay. Even if you're just there for a few days, you don't get as good quality of sleep. You're not in your normal surroundings. You're being thrown a ton of different information by a ton of different people. In our facilities, you get to see a lot of student learners too, so that kind of adds to the volume of people that you see. And when you get told you're getting ready to get discharged from the hospital, most patients are not really thinking about their next steps. They're just so excited to get home.
Host: Yeah, they just want to be home.
Christine Hutchinson: And that period is when a lot of our nurses and physicians really try to make sure patients know what their next steps are. But you haven't had a full night's sleep in however many days you've been there. You've seen how many ever different doctors throughout your stay. So, things like medications that were changed, the new doctors that you need to see. That's all in your discharge paperwork, but you may not even remember where you put that discharge paperwork, because you were so excited to get home. So, following up with your primary care doctor afterwards, that kind of helps you stay on track, make sure that you got everything you need to be doing for the next future so that way you don't end up admitted in the hospital again.
Host: Sort of like a regroup session, right?
Christine Hutchinson: Exactly.
Dr. Mandy Dailey: Yeah. It's a really important touch point. And I would say that no reason for hospitalization or no diagnosis for you going in there. Every single one of them is different, but every human who goes into the hospital is different and has different needs when they come out of the hospital. And your primary care doctor really is very well-equipped to be able to help you navigate that at that time. And it can be super confusing and not just because you're sleep-deprived, but there's new diagnoses, new medications. Maybe you're weakened by the fact that you were in there for multiple days. You know, you lay up in a bed for days at a time. I tell my patients, for every day you're in the hospital, it's a week outside of the hospital to get you back to where you were before you went in.
Host: Wow.
Dr. Mandy Dailey: And so, the physical deconditioning that happens when we lay you up in a bed for an entire day is a week of recovery, and that's without other injuries. And so, that's an incredible transition if you're thinking about all of the activities of daily living that you do at home and how you care for yourself or care for your family or care for your pets. All of those things need to be navigated.
Host: Yeah, that's massive. So, who tends to benefit the most from transitional care services? And can you give a few examples of situations that might make someone eligible or a good candidate, Christine?
Christine Hutchinson: Yeah. My number one answer is everyone.
Host: Okay.
Christine Hutchinson: Every single person should be following up with their primary care physician or provider after a hospital stay or even after an emergency room visit. There's some big conditions, you know, that we're really focused on, patients who have heart failure, patients who have diabetes, patients with lung conditions. Those are the ones that are especially high risk, but really every patient should be following up with their primary care provider, because you don't want to end up back in the hospital. I think it's the last thing you want when you get discharged.
Host: Right.
Dr. Mandy Dailey: And I think the anticipatory guidance is like the piece, that's what we call it in medicine of, like, how do I help you know what to expect or what is life-threatening or like not
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okay. So, we call that anticipatory guidance. That's kind of the counseling that we provide when we are talking about anything, whether it's a preventive visit. But that's really, really important in transitions, and coming out of the hospital. What to look for that is an emergent thing that actually you should go back to the hospital for, and what is not, what can we handle outpatient that you need to make sure you contact me for. And so, I think that that's a piece of this that is valuable from your PCP.
Host: Or even if you see that they need a specialist.
Dr. Mandy Dailey: Yeah. A hundred percent.
Host: It's like you're figuring out the pieces there and you're like, "Okay," then you can get them in front of the specialist.
Dr. Mandy Dailey: Hundred percent. I warn my patients that I'm extremely possessive of my patients, it is one of the reasons I chose family medicine to go into is because I'm really possessive of my patients. But family medicine and primary care is about relationships, and it's not just relationships with your patients, but it's the relationships with your specialists so that I can contact your electrophysiologist or your cardiologist or whoever and say, "Hey, here's our mutual patient. They're out of the hospital now. Here's what I've done so far. I'm handing off to you, and they really need to be seen in this amount of time based off of my clinical acumen," right? That's that navigation and that touchpoint that is really, really valuable and that everyone in primary care does.
Host: All right. So, I'm thinking there are going to be some people who are listening to this and who are thinking, "Oh boy, I don't have a primary care physician." What would you tell them, Dr. Dailey?
Dr. Mandy Dailey: I would say go get one. You need one. I think we have this idea that a primary care doctor, again, is maybe for like when I'm sick or I'm a healthy person, I don't need a primary care doctor. Like, honey, we are here for all of you, right? We are here to take care of all of you. And I also tell my patients, "I'm in charge of taking care of you, mind, body, and spirit."
And that's not only when you're sick. That's to keep you healthy. I would love to prevent you to ever having to go into the hospital. I would love to prevent injuries and chronic medical conditions for you. That's my job. So, if you don't have one, there are options of like you can go to an urgent care for transition care management and get your questions answered. You can absolutely do that. But I would really, really encourage anybody who's listening to find a primary care doctor who you can have a great relationship with, you can ask honest questions of, and you can develop a long-term relationship with who can really get to know you, your medical history, your lifestyle, to be able to take really good care of you and keep you healthy.
Host: Okay. So, one of the things that you mentioned, Christine, is obviously part of this is making sure you don't end up back in the hospital for maybe the same thing or a complication that could have been avoided. So, what are some of the common or most common reasons that people do end up back in the hospital after discharge, and how can a good follow-up care help prevent that, Christine?
Christine Hutchinson: Yeah. So, one of the most common reasons for someone to end up back in the hospital is usually medication-related.
Host: Okay.
Christine Hutchinson: So, either your medications were adjusted at your last hospital stay and maybe you didn't go through that 50-page discharge paperwork or maybe you didn't follow up with your primary care doctor. And so, you didn't realize those medications were changed or adjusted. Sometimes you do transition to the new medications and they have been changed or adjusted, but now you're having side effects you weren't expecting. And again, meeting with your primary care doctor can help you understand, are those expected? You know, is there something we can do about it? But the most common reason is medication related. It could be maybe you couldn't afford them. And if we know about that, there's usually alternatives that we can select that are more affordable.
Host: Yeah, that's a great point.
Dr. Mandy Dailey: I think too, like so much of our healthcare system is so complicated, so people assume that before they leave the hospital, they will leave with their bag of medications and everything will be self-explanatory, and it's not going to be packets of explanation and side effects that we give people on their medications. And we can do meds to bed. We can discharge you with medications that you can take with you, and that can be valuable. But a lot of patients go to the pharmacy and the medication's not ready yet. There is so many opportunities for medications to be a reason that they didn't get started or whatever.
So, it's not an easy thing to do. And so, it's important to have that medication reconciliation. I always recommend any doctor's appointment you go to, bring in all of your medications and all of your supplements that you take, because people really forget that sometimes the supplements they take can interact with some of your medications. And I actually want to see what's going down your gullet, and I actually want you to be able to talk to me and say I take this at this time" or, "I take this at this time," and be able to show me what you're taking and how you're taking it. Even if you bring in your pill box or anything like that, it's really, really helpful to kind of negate some of those outcomes that can happen if the medications and our interpretation of what you're taking and when, if it's not correct.
Host: And also if you're on many medications and they all have different rule: with food, without food, morning, night, don't take this with this, but take it with this.
Dr. Mandy Dailey: Yes.
Host: It's a puzzle.
Dr. Mandy Dailey: It is.
Christine Hutchinson: Even keeping track of which medication
bottle is the most recent medication bottle. Yeah. I mean, it can be really confusing once you get above eight medications, you are much more likely to get them mixed up and have an issue, and that's something your primary care doctor and the team can help you with.
And I tell people all the time, I tell my patients, "I'm the happiest doctor in the whole world if I prescribe you no medications." If I can get by with your nutrition and your exercise, and you have a community who loves and supports you, and all of your emotional needs are met, I have a lot less chronic disease management that I have to do as a family medicine doctor.
But the reality is that's not what our lives are. And so, we have a lot of these chronic medical conditions, and sometimes we do need these medications to be able to keep us healthy and to allow for longer lives. But with that comes complication. I hear eight medicines and I'm like, "I would never be able to manage eight medicines every single day." That's a lot.
Host: It's a lot. There are some patients—
Dr. Mandy Dailey: And there are lots of patients who are frequently over that amount of medications. And when you talk about side effects or interactions or just remembering to take all of them and when to take them, that's a lot to do. Fifty percent of our medical errors are in medications. And so, having somebody who can help navigate that with you can be really meaningful and can hopefully help you keep out of the hospital or have any side effects that don't require hospitalization.
Host: Right. Now, Dr. Dailey, we covered the medication piece of this that can sometimes be a stumbling block for people. What can patients and maybe caregivers too do to make the hospital to home transition smoother and safer?
Dr. Mandy Dailey: I think the biggest thing that I would encourage patients to do is ask as many questions as possible. If you don't know the answer or if you feel unclear on something, ask the question, and ask the question of your nurse, ask of your care manager, ask of your doctors, ask of your APPs. Ask the questions, because I think a lot of times people are so excited, like, "I get to go home and sleep in my own bed." And they just are like, "Just get me out of here. I'll figure it out on the back end." And then, they have a lot of questions that go unanswered after the fact. And so, I think it's really important, ask your questions. Don't feel like there are silly questions. Our healthcare system is really, really complicated. And so, if you're like, "Where am I going to get that walker that you're telling me I need before I leave or to safely ambulate out and about in my home?" Ask the question.
Host: That's a great call-out.
Dr. Mandy Dailey: Right? Like, ask the question. And don't be afraid to ask those questions because that transition is really, really important. When I'm discharging somebody from the hospital, I want to know that they're safe to go home. If they're not safe to go home, then I
don't want them leaving the hospital yet.
Also, we require a lot of our caregivers in this country to take care of people. And so, like, we kind of do depend on your family or loved ones to kind of help in some of that transition. I don't necessarily think that that's fair, but it is something that we need buy-in and we need your caregivers to understand where you're going to be when you come home.
Host: Yeah.
Dr. Mandy Dailey: And what you're going to be capable of.
Host: If somebody's blessed to have somebody with them that can help take notes and be a second brain asking those questions. Because sometimes, the patient is not in a state to be thinking clearly to ask the questions.
Christine Hutchinson: Yes.
Dr. Mandy Dailey: An advocate.
Host: Correct.
Christine Hutchinson: Yep. And it can be hard sometimes, too. Doctors can be pretty intimidating. And Dr. Dailey, plug your ears, but they often use words that patients really, and people don't always understand. So if you don't understand something, I think most doctors know that they have that problem. Don't be afraid to say, "Can you explain that in a different way? I don't think I understood what you meant." Because if the doctor thinks you understood everything they just told you, they're going to think everything's good, but you may not have picked up on some of the language that they used. Don't be afraid to ask. And if you're too scared to tell the doctor, don't be afraid to ask a nurse.
Dr. Mandy Dailey: Yes.
Host: That's a good point, too. Okay. So as we wrap up this conversation here, Christine, if listeners could take away one message from this conversation about recovering after a hospitalization, what would you want them to remember?
Christine Hutchinson: I would say be brave, ask questions.
Host: I like that. You, Dr. Dailey?
Dr. Mandy Dailey: Ooh, short and succinct.
Host: Yes, I know. That was really good. Were you ready? It's your turn.
Dr. Mandy Dailey: I was not ready. I think the biggest thing is invest in a primary care who's going to invest in you. And I think that whether we're talking about hospitalization or just wanting to do the best for yourself and for your longevity and your health, I am biased because this is what I do for a living, but I think it's the best investment you can make in your health and wellbeing is to have a primary care that you're invested in and who's invested in you.
Host: Wonderful. Thank you so much, Dr. Dailey, Christine, for being on our podcast today.
Dr. Mandy Dailey: Yeah, thank you so much for the opportunity.
Christine Hutchinson: Thank you. This is great.
Host: Thanks. That has been Dr. Mandy Dailey and Christine Hutchinson. For more information, please visit www.tgmg.org. If you enjoyed this episode, please be sure to like, subscribe, and follow Community Connect: presented by TGH, on your favorite podcast platform. I'm Karen Loftus. And this is Community Connect: presented by TGH. Thanks for listening.
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