Ensuring safe, quality care for hospitalized people with advanced illness, a core obligation for hospitalists

Communication, palliative care, and patient safety have been identified by the Society of Hospital Medicine as core competencies in hospital medicine. Effective communication is recognized as being “central to the role of the hospitalist to promote efficient, safe, and high quality care....” Hospitalists are increasingly recognized as having a central role in initiatives to improve palliative care for hospitalized patients and their families and have a vital role in leading and participating in interventions to mitigate system and process failures that affect patient safety. The obligation of the hospitalist to assure safe, quality care for hospitalized people with advanced illness extends from direct patient care to advocacy for systems that facilitate the provision of such care. Four articles in this issue of the Journal of Hospital Medicine provide complementary perspectives on these crucial roles of the hospitalist. Cherlin and colleagues describe findings from a survey of hospitalists and medical residents regarding their knowledge, attitudes, and practices relative to caring for patients with terminal illness. The article identifies misperceptions related to core components of quality palliative care: pain and symptom control, hospice eligibility, and communication about prognosis and hospice and palliative care. Although this study was conducted at only a single academic medical center and certainly deserves to be repeated in an expanded and more representative sample, it clearly identifies deficits in core components of quality care for persons with advanced illness. The article by Minichiello and colleagues provides practical guidance and resources for addressing one of the deficits identified: communicating a poor prognosis, or “bad news.” Pain and symptom management and communication are commonly recognized aspects of quality care for persons with advanced illness. Less often appreciated are the significant threats to patient safety and medical errors that occur in the care of this vulnerable population. Potential errors include failure of a planned action to be completed as intended (ie, not following advance directives) and failure to treat symptoms adequately. The original research article and accompanying images discussion by Sehgal and colleagues serve as a call to action to both recognize and address the potentially significant patient safety issue related to the use of color-coded wristbands, particularly variation in color used by different hospitals to designate “do not resuscitate” E D I T O R I A L