Lincoln, Neb., June 2007 - NRC Picker recognizes that continuity of care is essential as a patient transitions to home.  Inadequate transfer of information after hospital discharge has been associated with errors in care and contributes to a greater risk for a patient's potential readmission to the hospital.  A recently published systematic review of the literature examined this issue for specific areas of communication deficits, potential solutions and associated clinical outcomes (Kripalani et al., 2007). The findings of this review provide a basis for assessing information transfer processes in an effort to evaluate and assure safe continuing care for patients post-hospitalization. 

Effective communication of patient status and continuing health needs are critical elements in the provision of safe, patient-centered healthcare. This is especially true at both junctures and when "hand-offs" in the patients care occur as between hospital-based and primary care physicians upon a patient's acute care discharge.  Ask yourself the following questions:
 
Is the communication and transfer of information timely?
Primary care physicians report greater satisfaction when relevant discharge components are communicated within one week of a patient's hospital stay. At most U.S. hospitals, the Joint Commission for Accreditation of Healthcare Organizations standard is upheld allowing physicians 30 days after the patient is dismissed to complete a discharge summary. If the primary provider is without the critical information on their patient's most recent healthcare experience, errors in continuing care are more likely.

Does the communication contain the right information?
In addition to needing the timely transfer of patient information, primary care physicians (PCPs) have identified the essential components of information that will enable them to safely care for patients post-hospitalization.

Is the communication accurate, complete and effective?
Physicians prefer to receive reports with structured, concise formats and clear subheadings over the traditional dictated report. Structured reports are often accomplished through computer-generated forms. Computerized forms decrease the omission rate of essential information as electronic medical records (EMRs) allow data, found elsewhere in the medical record, to be extracted into the appropriate field. Unfortunately, most hospitals do not yet utilize EMRs.  If this is the case, a standardized template for dictation is an effective option.  Use of a template, inclusive of the essential discharge components, is associated with a significant improvement in the perceived quality of the dictated report, albeit dictated reports often lack the timeliness of computer-generated reports.

Utilization of Evidence in Improving Hospital Systems and Processes
The review by Kripalani et al. (2007) included 55 observational studies of communication and information transfer in hospitals and 18 controlled studies evaluating the efficacy of interventions to improve information transfer.

NRC Picker concurs that assuring the timely transfer of accurate patient information, from the attending hospital physician to the patient's primary care provider, contributes greatly to safe patient-centered healthcare. In light of this research, examining current patient information transfer processes and optimizing the timely communication of essential elements will help to safely transition the patient from the hospital setting.

References:
Kripalani, S., LeFevre, F., Phillips, C. O., Williams, M. V., Basaviah, P., & Baker, D. W. (2007). Deficits in communication and information transfer between hospital-based and primary care physicians: Implications for patient safety and continuity of care. JAMA, 297(8), 831-841.