Medical errors related to discontinuity of care from an inpatient to an outpatient setting

Abstract

OBJECTIVE:To determine the prevalence of medical errors related to the discontinuity of care from an inpatient to an outpatient setting, and to determine if there is an association between these medical errors and adverse outcomes. PATIENTS:Eighty-six patients who had been hospitalized on the medicine service at a large academic medical center and who were subsequently seen by their primary care physicians at the affiliated outpatient practice within 2 months after discharge.DESIGN: Each patient's inpatient and outpatient medical record was reviewed for the presence of 3 types of errors related to the discontinuity of care from the inpatient to the outpatient setting: medication continuity errors, test follow-up errors, and work-up errors. MEASUREMENTS:Rehospitalizations within 3 months after the initial postdischarge outpatient primary care visit.MAIN RESULTS: Forty-nine percent of patients experienced at least 1 medical error. Patients with a work-up error were 6.2 times (95%confidence interval [95% CI], 1.3 to 30.3) more likely to be rehospitalized within 3 months after the first outpatient visit. We did not find a statistically significant association between medication continuity errors (odds ratio [OR], 2.5; 95%CI, 0.7 to 8.8) and test follow-up errors (OR, 2.4; 95%CI, 0.3 to 17.1) with rehospitalizations. CONCLUSION:We conclude that the prevalence of medical errors related to the discontinuity of care from the inpatient to the outpatient setting is high and may be associated with an increased risk of rehospitalization.KEY WORDS: medical errors; continuity of care; discharge plan; discharge summary. J GEN INTERN MED 2003;18:646±651. A dverse events in hospitalized patients have been associated with the discontinuity of care that occurs during the handoff of patient care from one hospital-based physician to another, 1 and there is evidence that improved communication between hospital-based physicians may decrease adverse events. 2 However, relatively little attention has been given to the spectrum of medical errors and adverse events that are caused by inadequate communication between hospital-based physicians and outpatient primary care providers (PCPs). Physicians caring for hospitalized patients often formulate discharge plans that include medication regimens that are to be continued after discharge, scheduled outpatient tests and procedures, and test results that are pending at discharge and that need to be followed up by the outpatient PCP. The Institute of Medicine defines a medical error as``failure of a planned action to be completed as intended. '' 3 Based on this definition, failure to implement the intended discharge plan for a recently hospitalized patient constitutes a medical error, assuming the PCP concurs with the plan or, if not, fails to change the plan. However, studies have shown that less than half of all PCPs are provided information about the discharge medications and plans for their recently hospitalized patients, 4±6 this despite evidence that access to relevant discharge in...

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