In an article published in the Feb. 28, 2007, Journal of the American Medical Association, researchers conclude that hospitals and primary care physicians should improve the ways in which they communicate with each other, in order to insure patient safety and continuity of care.
Sunil Kripalani, MD, MSc, assistant professor, Emory University School of Medicine, and hospitalist at Grady Memorial Hospital, and colleagues found there is often a large gap between the time a patient is discharged from the hospital and when the patient's primary care physician receives information related to the patient's diagnosis, treatment and follow-up needs.
"The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) requires that discharge summaries be completed within 30 days of hospital discharge," says Dr. Kripalani. "However, many patients will follow-up with their primary care physician (PCP) much sooner than that, often before the discharge summary has arrived by mail. If the PCP does not have detailed information about what happened during the hospitalization, he or she is less able to provide the patient with high-quality follow-up care."
In the past, a discharge summary was used primarily for documentation of acute hospital stays, and there was little need for transferring information from one physician to another because the same physician often provided both the inpatient and outpatient care.
Now hospitalists, or physicians whose primary professional focus is in the care of hospitalized patients, are becoming more prevalent in many hospitals. Under this model, PCPs hand over the care of patients to a hospitalist at the time of hospital admission and then resume care after the patient returns home.
Hospitalists provide many benefits, including greater availability to oversee patient care during the day, shorter hospital stays, lower costs and in some cases, better patient outcomes. Hospitalists are actively working to improve hand-offs with other physicians, as they affect the continuity and quality of patient care.
In this study, which did not focus on hospitalists, Dr. Kripalani summarized data from 55 published studies on the availability, timeliness, content and format of discharge communications as well as primary care physician satisfaction. The research team found that the quality of discharge summaries needed to be substantially improved and that summaries needed to be delivered more quickly to primary care physicians.
The researchers also reviewed studies to improve the transfer of patient information at hospital discharge, which allowed them to compile recommendations on how to improve communication.
One of the recommendations was the use of health information technology that can be configured to deliver information through fax or email to designated outpatient physicians on the day of discharge. This would eliminate delays associated with mailing discharge information to physicians' offices. Many hospitalists also contact PCPs by telephone on the day of discharge to convey the most relevant patient information and follow-up needs.
Another recommendation was for the hospital to provide a copy of the most pertinent data to newly discharged patients, who could hand-deliver this information to the primary care physician at the first follow-up visit.
"The period following hospital discharge is a vulnerable time for patients, when they often must obtain additional tests and manage new medications in order to complete their recovery," says Dr. Kripalani. "Using straightforward approaches to improve communication between inpatient and outpatient physicians will help insure that responsibility for patient care is passed with confidence and certainty, and that patients will receive the best follow-up care possible."