Communication and coordination of care among providers.

Every defect is a treasure Quality problems that result in adverse outcomes provide opportunities for quality improvement. A series based on actual examples of care. A patient under treatment with clozapine for chronic paranoid schizophrenia dies of overwhelming sepsis. A 48-year-old male seeks treatment for chronic paranoid physician–patient discussion, enrolls the patient in the schizophrenia. His psychiatrist recommends clozapine decision-making process and may increase the likelihood and discusses the risks and benefits of the drug with of compliance with a treatment regimen. Of course, the patient, especially noting the relatively high incidence medical concepts such as agranulocytosis should be of agranulocytosis. The patient agrees to the treatment. explained in lay terms to patients. He understands the clozapine prescription must be renewed weekly, and that renewal is contingent upon satisfactory white blood cell counts.. Over-reliance on a previous diagnosis without considering The patient is highly motivated and follows the med-new information – including the fact that a condition has ication instructions closely. The few times he is unable not responded to treatment as predicted – can lead to to keep his psychiatric appointment, he sees his internist error. Documenting the rationale for an initial diagnosis, as instead for the necessary blood work. The internist then well as the bases for confirming or ruling out others, can faxes the test results to the psychiatrist. facilitate reconsideration of the matter as time passes and additional treatment options are pursued.. In the event of abnormal clinical findings, the provider' s Sixteen months into the treatment the patient presents response should be commensurate with the risk indicated to a hospital emergency department complaining of by the results. A potentially fatal infection warrants direct lower abdominal pain and urinary retention. He is communication among providers rather than reliance on admitted, treated for fecal impaction, and discharged the patient to both understand and transmit abnormal the next day. Three days later, he cancels his psychiatric test results to other treaters. appointment due to continued bowel problems. He reschedules the appointment for later in the week, and It is helpful to educate office staff about handling reports that his internist is overseeing his care. However, telephone calls and to review periodically the principles of after another 2 days pass, the patient again calls the telephone triage. Some staff members may be inclined to psychiatrist saying he does not feel well enough to come 'protect' providers from telephone calls; …