Deficits in Communication and Information Transfer Between Hospital-Based and Primary Care Physicians

Abstract

S THE SPECIALTY OF HOSPItal medicine expands, the transfer of responsibility for p a t i e n t c a r e b e t w e e n hospital-based physicians (hospitalists) and primary care physicians becomes increasingly common, creating an urgent need to improve communication and information transfer between inpatient and outp a t i e n t p h y s i c i a n s a t h o s p i t a l discharge. [1][2][3] Timely transfer of accurate, relevant data about diagnostic findings, treatment, complications, consultations, tests pending at discharge, and arrangements for postdischarge follow-up may improve the continuity of this handoff. 4,5 By contrast, delayed communication or inaccuracies in information transfer among health care professionals, particularly during the early postdischarge period, may have substantial implications for continuity of care, patient safety, patient and clinician satisfaction, and resource use. [6][7][8][9][10] The discharge summary is the most common method for documenting a patient's diagnostic findings, hospital management, and arrangements for postdischarge follow-up. The Joint Context Delayed or inaccurate communication between hospital-based and primary care physicians at hospital discharge may negatively affect continuity of care and contribute to adverse events. Objectives To characterize the prevalence of deficits in communication and information transfer at hospital discharge and to identify interventions to improve this process. Data Sources MEDLINE (through November 2006), Cochrane Database of Systematic Reviews, and hand search of article bibliographies.Study Selection Observational studies investigating communication and information transfer at hospital discharge (n=55) and controlled studies evaluating the efficacy of interventions to improve information transfer (n=18). Data ExtractionData from observational studies were extracted on the availability, timeliness, content, and format of discharge communications, as well as primary care physician satisfaction. Results of interventions were summarized by their effect on timeliness, accuracy, completeness, and overall quality of the information transfer.Data Synthesis Direct communication between hospital physicians and primary care physicians occurred infrequently (3%-20%). The availability of a discharge summary at the first postdischarge visit was low (12%-34%) and remained poor at 4 weeks (51%-77%), affecting the quality of care in approximately 25% of follow-up visits and contributing to primary care physician dissatisfaction. Discharge summaries often lacked important information such as diagnostic test results (missing from 33%-63%), treatment or hospital course (7%-22%), discharge medications (2%-40%), test results pending at discharge (65%), patient or family counseling (90%-92%), and follow-up plans (2%-43%). Several interventions, including computer-generated discharge summaries and using patients as couriers, shortened the delivery time of discharge communications. Use of standardized formats to highlight the most pertinent information im...

Provider Characteristics, Clinical-Work Processes and Their Relationship to Discharge Summary Quality for Sub-Acute Care Patients

“…1 Only 3% of posthospital providers receive discharge information via verbal communication, 2 and other means of written communication are not universally present. 3 The Joint Commission (TJC) mandates that a discharge summary be produced for every patient by the hospital provider within 30 days of discharge, 4 and include (1) reason for hospitalization; (2) procedures performed; (3) care, treatment, and services provided; (4) discharge condition; (5) information provided to the patient/family; and (6) attending physician signature.…”

“…4 Experts advocate for more numerous and specific components, such as discharge medications, follow-up instructions, and diet, to better support patient safety during care transitions. 1,[5][6][7][8][9][10][11] Hospital patients commonly discharged to sub-acute care settings, such as hip fracture and stroke patients, 12,13 rely on the discharge summary to ensure appropriate care. Sub-acute care transitions are system-to-system transfers that usually result in completely new patient care teams.…”

“…Sub-acute care transitions are system-to-system transfers that usually result in completely new patient care teams. 1,14 The discharge summary may be the only document accompanying the patient and is frequently the document from which sub-acute admission orders are directly transcribed. 1,11,14 Since the attending physician for the sub-acute care stay may take up to 30 days to see a newly admitted patient, 14 the discharge summary's content can dictate the patient's care for an extended period of time.…”

“…1,14 The discharge summary may be the only document accompanying the patient and is frequently the document from which sub-acute admission orders are directly transcribed. 1,11,14 Since the attending physician for the sub-acute care stay may take up to 30 days to see a newly admitted patient, 14 the discharge summary's content can dictate the patient's care for an extended period of time. Furthermore, since sub-acute care patients are often vulnerable, medically complex, and cognitively impaired, 12,15 they are less likely to advocate effectively for themselves if poor discharge communication occurs.…”

Dual Healthcare System Use During Episodes of Acute Care Heart Failure Associated With Higher Healthcare Utilization and Mortality Risk

“…For instance, hospital discharge summaries are frequently unavailable at the time of first hospital follow‐up, and deficiencies in timeliness and quality exist 37. Within the VA healthcare system, records from outside hospital facilities must be optically scanned into a separate area of the electronic health record not readily visible to VA providers, and similar challenges exist in sharing information from VA to the community 38.…”