Obstacles and Opportunities in Information Transfer Regarding Medications at Discharge – A Focus Group Study with Hospital Physicians

Abstract

Purpose This qualitative study aimed to investigate experiences and perceptions of hospital physicians regarding the discharging process, focusing on information transfer regarding medications. Methods By purposive sampling three focus groups were formed. To facilitate discussions and maintain consistency, a semi-structured interview guide was used. Discussions were audio recorded and transcribed verbatim. Qualitative content analysis was used to analyze the anonymized data. A confirmatory analysis concluded that the main findings were supported by data. Results Identified obstacles were divided into three categories with two sub-categories each: Infrastructure ; IT-systems currently used are suboptimal and complex. Hospital and primary care use different electronic medical records, complicating matters. The work organization is not helping with time scarcity and lack of continuity. Distinct routines could help create continuity but are not always in place, known, and/or followed. Physician : knowledge and education in the systems is not always provided nor prioritized. Understanding the consequences of not following routines and taking responsibility regarding the medications list is important. Not everyone has the self-reliance or willingness to do so. Patient/next of kin : For patients to provide information on medications used is not always easy when hospitalized. Understanding information provided can be hard, especially when medical jargon is used and there is no one available to provide support. A central theme, “ We're only human ”, encompasses how physicians do their best despite difficult conditions. Conclusion There are several obstacles in transferring information regarding medications at discharge. Issues regarding infrastructure are seldom possible for the individual physician to influence. However, several issues raised by the participating physicians are possible to act upon. In doing so medication errors in care transitions might decrease and information transfer at discharge might improve.

Life‐threatening bronchospasm induced by an angiotensin‐converting enzyme inhibitor in a chronically ventilated patient: Diagnostic pitfalls and literature review

“…Finally, the lack of continuity in medical care among patients moving from one medical care system to another is an additional plausible factor in overlooking ACEi‐mediated adverse effects. The transfer of patients between primary care and ambulatory or non‐ambulatory medical systems or between critical care units and regular wards forms a frail link in the chain of securing the continuity of appropriate medical assessment 23,24 . Although lists of medications and known allergies are mandatorily provided during the transition of care, the rationale for therapeutic decisions is often not detailed in discharge or referral letters.…”

“…The transfer of patients between primary care and ambulatory or non‐ambulatory medical systems or between critical care units and regular wards forms a frail link in the chain of securing the continuity of appropriate medical assessment. 23 , 24 Although lists of medications and known allergies are mandatorily provided during the transition of care, the rationale for therapeutic decisions is often not detailed in discharge or referral letters. It is tempting to assume that treatment with ACEi in our patient was not resumed during prolonged postsurgical critical care management because of the emergence of adverse respiratory effects.…”

Identifying older adults at increased risk of medication-related readmission to hospital within 30 days of discharge: development and validation of a risk assessment tool

“…Improving medication use as well as transitions of care has been shown to be important factors when aiming to reduce the frequency of medication-related readmissions 11 12. Including clinical pharmacists in the interdisciplinary team, to help with medication reconciliation and medication review as well as information transfer and follow-up regarding medications and medication changes, can support this 12 45–47. The HOME Score can be used to find the patients in most need of this support.…”

The complexities of communication at hospital discharge of older patients: a qualitative study of healthcare professionals’ views

“…However, in contrast to previous research, our study was performed in the context of a shared EHR between the hospital and primary healthcare centres. In previous studies [35,37,59] a shared EHR was proposed as a possible solution to the communication problems experienced during discharge. Although we believe that the problematic communication gap is probably diminished to some extent with a shared EHR, several of the problems pertaining to correctness of information and delayed discharge summaries still seem to be present.…”