As a long distance runner on my high school track team, I won few accolades in individual events, but shone in relays. My teammates and I spent hours perfecting our baton exchanges, which must occur within a limited area of the track, until these handoffs felt smooth and effortless. In contrast, world class athletes focused on individual performances are often assigned to relay teams at the last minute, a practice that led to stunning disqualifications for dropped batons of both the U.S. men’s and women’s 4 x 100 meter relay teams at the Beijing Olympics.
Dropped handoffs in medicine can expose patients to harm, too, even if individual clinicians are exceptionally skilled. An editorial in American Family Physician reviewed studies of programs designed to improve care transitions from hospital to home and found mixed evidence that such programs improve health outcomes:
Although some programs reduced 30-day rehospitalization rates, a systematic review found that no single intervention is reliably helpful, and successful readmission reduction programs generally occur only in single institutions. However, it seems that programs that focus on the whole patient rather than a specific diagnosis are more successful in reducing readmissions. This concept is in keeping with the focus of primary care physicians. To solve the challenge of care transitions, the primary care physician should have a prominent role at three times: at admission, immediately after discharge, and at the post-discharge follow-up visit.