Delays and lack of communication to primary care physicians common after hospital discharge

Primary care physicians often do not receive adequate patient information from the hospital-based physician following discharge, according to a review article in the February 28 issue of JAMA: The Journal of the American Medical Association.

According to background information in the article, "As the specialty of hospital medicine expands, the transfer of responsibility for patient care between hospital-based physicians and primary care physicians becomes increasingly common, creating a need to improve communication and information transfer between inpatient and outpatient physicians at hospital discharge. Timely transfer of accurate, relevant data about diagnostic findings, treatment, complications, consultations, tests pending at discharge, and arrangements for postdischarge follow-up" is important. "Delayed communication or inaccuracies in information transfer among health care professionals, particularly during the early postdischarge period, could have substantial implications for continuity of care, patient safety and patient and clinician satisfaction." The extent to which physicians successfully transfer timely and accurate patient information at hospital discharge is uncertain.

Sunil Kripalani, M.D., M.Sc., of the Emory University School of Medicine, Atlanta, and colleagues performed a review of medical literature to characterize the types and prevalence of deficits in communication and information transfer between hospital-based physicians and primary care physicians at hospital discharge. The researchers analyzed 55 observational studies investigating communication and information transfer at hospital discharge and 18 controlled studies evaluating the efficacy of interventions to improve information transfer.

The researchers found that direct communication between hospital physicians and primary care physicians during the discharge process occurred infrequently. Only 3 percent of primary care physicians reported being involved in discussions about discharge, and 17 percent to 20 percent reported always being notified about discharges.

"The availability of a discharge summary at the first postdischarge visit was low (12 percent - 34 percent) and remained poor at 4 weeks (51 percent - 77 percent), affecting the quality of care in approximately 25 percent of follow-up visits and contributing to primary care physician dissatisfaction. Discharge summaries often lacked important information such as diagnostic test results (missing from 33 percent - 63 percent), treatment or hospital course (7 percent - 22 percent), discharge medications (2 percent - 40 percent), tests results pending at discharge (65 percent), patient or family counseling (90 percent - 92 percent), and follow-up plans (2 percent - 43 percent)," the researchers write.

"Several interventions, including computer-generated discharge summaries and using patients as couriers shortened the delivery time of discharge communications. Use of standardized formats to highlight the most pertinent information improved the perceived quality of documents."

"Deficits in communication and information transfer between hospital-based physicians and primary care physicians are substantial and ubiquitous. The traditional methods of completing and delivering discharge summaries are suboptimal for communicating timely, accurate, and medically important patient data to the physicians who will be responsible for follow-up care. Urgent improvements are needed in the processes and formats used for transferring information to primary care physicians at hospital discharge," the authors write.

"A number of interventions appear effective in improving the timeliness and perhaps quality of discharge summaries, and application of health information technology bears particular promise. The baton of responsibility for patient care must be passed with confidence and certainty while ensuring that important information is not dropped during patient transitions from acute hospital care to the community," the researchers conclude.