Searching for the missing pieces between the hospital and primary care: mapping the patient process during care transitions

Abstract

Background: Safe patient transitions depend on effective communication and a functioning care coordination process. Evidence suggests that primary care physicians are not satisfied with communication at transition points between inpatient and ambulatory care, and that communication often is not provided in a timely manner, omits essential information, or contains ambiguities that put patients at risk. Objective: Our aim was to demonstrate how process mapping can illustrate current handover practices between ambulatory and inpatient care settings, identify existing barriers and facilitators to effective transitions of care, and highlight potential areas for quality improvement. Methods: We conducted focus group interviews to facilitate a process mapping exercise with clinical teams in six academic health centres in the USA, Poland, Sweden, Italy, Spain and the Netherlands. Findings: At a high level, the process of patient admission to the hospital through the emergency department, inpatient care, and discharge back in the community were comparable across sites. In addition, the process maps highlighted similar barriers to providing information to primary care physicians, inaccurate or incomplete information on referral and discharge, a lack of time and priority to collaborate with counterpart colleagues, and a lack of feedback to clinicians involved in the handovers. Conclusions: Process mapping is effective in bringing together key stakeholders and makes explicit the mental models that frame their understanding of the clinical process. Exploring the barriers and facilitators to safe and reliable patient transitions highlights opportunities for further improvement work and illustrates ideas for best practices that might be transferrable to other settings.

Clinical handover within the emergency care pathway and the potential risks of clinical handover failure (ECHO): primary research

“…79 Process mapping was also a key tool for understanding the discharge process as part of the HANDOVER project funded by the European Union. 80 The purpose of the familiarisation phase was to enable the researcher to build an initial understanding of the flow of activities, and to identify suitable staff roles for participation in the subsequent process mapping session.…”

Evaluation of a children's hospital's direct admission process to improve outcomes and efficiency of care.

“…It has been suggested that primary care phsicians are not satisified with communication at transition points because communication is not provided in a timely manner, omits essential information, or contains ambiguities that put patients at risk (Johnson, et al, 2012;Kripalani, LeFevre, Phillips, Williams, Basaviah, & Baker, 2007). This can be seen in KCH and shows the need for the AEU to have a standardized data collection form that omits the ambiguties and contains questions to receive the essential information quickly.…”

“…Another study performed by Johnson et al used clinical teams from six countries to create a process map and determine the missing pieces during care transitions (2012). The process map showed them similar barriers to providing information to primary care physicians, inaccurate or incomplete information on referral and discharge, problems with collaboration with counterpart colleagues, and lack of feedback to clinicians involved in the handovers (Johnson et al, 2012). were performed in six academic health centers around the world in a study aimed to demonstrate how process mapping could 1) illustrate handover practices between ambulatory and inpatient care settings, 2) identify barriers and facilitators to effective transitions of care, 3) and identify areas for quality improvement (Johnson, et al, 2012 …”

“…This tool allows all the steps that make up a patient's visit visible to everyone (de Bucourt, et al, 2012;Johnson, et al, 2012;Ben-Tovin et al, 2008). To aid the investigation of above topic 5 concerning the process flow of the AEU, a magnetic whiteboard was used with the different process steps labeled on magnets to map out the process, Figure 4.…”

“…Whether it has been research performed on medication reconciliation (Baker, Lindquist, Liss, & Noskin, 2010;Stone, Boehme, Mundorff, Maloney, & Sriastava, 2010;Unroe, Pfeiffenberger, Riegelhaupt, Jastrzembski, Lokhnygina, & Colón-Emeric, 2010), effects on the admission unit when patients with a particular sickness, disease, or a particular age are admitted (Kafetz, 2010;Flanagan, Ellis, Baggott, Grimsehl, & English, 2010;Simon, et al, 2010), or admission process improvement (Johnson, et al, 2012;Huang, Thind, Dreyer, & Zaric, 2010), it is recognized as the beginning of the treatment process and, if performed efficiently, the first critical step towards improved patient outcomes. Hence, the need for improvement is always present.…”