Assessing written communication during interhospital transfers of emergency general surgery patients

Abstract

Background Poor communication causes fragmented care. Studies of transitions of care within a hospital and on discharge suggest significant communication deficits. Communication during transfers between hospitals has not been well studied. We assessed the written communication provided during interhospital transfers of emergency general surgery patients. We hypothesized that patients are transferred with incomplete documentation from referring facilities. Methods We performed a retrospective review of written communication provided during interhospital transfers to our emergency department (ED) from referring EDs for emergency general surgical evaluation between January 1, 2014 and January 1, 2016. Elements of written communication were abstracted from referring facility documents scanned into the medical record using a standardized abstraction protocol. Descriptive statistics summarized the information communicated. Results A total of 129 patients met inclusion criteria. 87.6% (n = 113) of charts contained referring hospital documents. 42.5% (n = 48) were missing history and physicals. Diagnoses were missing in 9.7% (n = 11). Ninety-one computed tomography scans were performed; a mong 70 with reads, final reads were absent for 70.0% (n = 49). 45 ultrasounds and x-rays were performed; among 27 with reads, final reads were missing for 80.0% (n = 36). Reasons for transfer were missing in 18.6% (n = 21). Referring hospital physicians outside the ED were consulted in 32.7% (n = 37); consultants’ notes were absent in 89.2% (n = 33). In 12.4% (n = 14), referring documents arrived after the patient’s ED arrival and were not part of the original documentation provided. Conclusions This study documents that information important to patient care is often missing in the written communication provided during interhospital transfers. This gap affords a foundation for standardizing provider communication during interhospital transfers.

Assessing adequacy of emergency provider documentation among interhospital transferred patients with acute aortic dissection

“…Prior studies indicate that documentation regarding interhospital transferred patients has been poor. [12,13] In one case, 33% of ED records missed documentation of consultation for patients who were transferred from referring EDs to a tertiary care center. [12] Furthermore, poor documentation of clinical care from referring providers resulted in more adverse events and more testing at the accepting facilities, while complete transfer documentation was associated with lower in-hospital mortality at the accepting hospitals.…”

“…[12,13] In one case, 33% of ED records missed documentation of consultation for patients who were transferred from referring EDs to a tertiary care center. [12] Furthermore, poor documentation of clinical care from referring providers resulted in more adverse events and more testing at the accepting facilities, while complete transfer documentation was associated with lower in-hospital mortality at the accepting hospitals. [13] Our study data showed that adequate documentation of EMTALA compliance was significantly associated with AoD patients having SBP meeting the AHA guidelines.…”

“…To date, there is no standard for assessing the quality of documentation for interhospital transferred patients. [12] Each investigator uses different definitions for their studies involving transferred patient documentation. For example, in Harl et al, [12] the investigators considered inclusion of laboratory values and any digital imaging studies on compact discs as adequate documentation among patients who were transferred for surgical interventions from EDs.…”

“…[12] Each investigator uses different definitions for their studies involving transferred patient documentation. For example, in Harl et al, [12] the investigators considered inclusion of laboratory values and any digital imaging studies on compact discs as adequate documentation among patients who were transferred for surgical interventions from EDs. Yet, Usher et al, [13] which involved the transfer of admitted patients, considered presence of progress notes, reconciliation of medications, and discharge summaries as important components.…”

“…[8] Previous studies have indicated that documentation of clinical care among interhospital transferred patients is inadequate. [12,13] However, the quality of documentation of clinical care for interhospital transferred patients with acute aortic dissections among emergency providers (EP) is unknown. This study investigated how well EPs documented their clinical care and their compliance with existing interhospital transfer guidelines according to EMTALA statutes.…”