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Lien K, Grattan BA, Reynard AL, Peters J, Parr JL. Factors Associated with Family Physician Follow-up 30 Days Post-discharge from a Local Canadian Community Emergency Department. Cureus 2020; 12:e7008. [PMID: 32206472 PMCID: PMC7077740 DOI: 10.7759/cureus.7008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction Close outpatient follow-up with a specialist or family physician post-discharge from the emergency department (ED) has been shown to increase adherence to antihypertensive medications, decrease mortality in heart failure, and reduce the odds of myocardial infarction or death after ED presentation for chest pain. A Canadian study demonstrated that 21% of patients who left the ED with a new diagnosis of atrial fibrillation, heart failure, or hypertension were not seen by a physician within 30 days. There is a paucity of research investigating why this follow-up does not occur. This study aimed to elucidate factors that are associated with outpatient follow-up by a family physician clinic following discharge from a local Canadian community emergency department. Methods A retrospective chart review of patients rostered to a family physician who presented to the community ED in the past two years was conducted. The primary outcome examined was a documented follow-up visit with any physician at the clinic within 30 days of the index ED visit. Patients aged 18 or older at the time of the initial ED visit were eligible for inclusion in the study. Exclusion criteria were the following: patients aged 17 or younger at the time of the initial ED visit, those who were not fully assessed at ED visit (i.e., left against medical advice), those whose charts corresponding to the ED visit were unable to be found, patients who were admitted to any facility within 30 days of ED visit, and patients who died within 30 days of the ED visit. Variables of interest extracted from the ED chart and clinic electronic medical record were the following: Canadian Triage and Acuity Scale (CTAS) score, documented discharge instructions, age, sex, primary residence distance from the clinic, last documented clinic visit before ED visit, and the date of and presenting complaint of the next clinic visit after the ED visit. Data were collected as continuous and categorical variables. Descriptive statistics were used to show the number and percentages of patients who followed up in clinic. Binomial regression analysis was used to determine if a specific variable was associated with patient follow-up. Inter-rater reliability between data abstractors was calculated using Fleiss Κ. An alpha-value of 0.05 was chosen, and SPSS version 25.0 (IBM Corp., Armonk, NY) was used for all statistical analyses. Results A total of 234 patients out of 1292 patients met inclusion criteria. 53% of patients were female, and the mean age was 50. Seventy-two (31%) received discharge instructions from the ED physician to follow up with their family doctor. In total, 93 of the 234 patients proceeded to have a documented clinic visit within 30 days (40%). 52% (n = 48) of these were women. Receiving specific discharge instructions increased the adjusted odds of follow-up (OR 3.07, 95% CI: 1.64-5.76; P < 0.05). Patients who followed up also tended to have been seen in clinic in the last three months, but this was not statistically significant. Conclusion Receiving specific discharge instructions to follow-up increased the odds that patients followed up with their family physician after discharge from the ED. ED physicians may consider giving explicit instructions to patients to improve monitoring of ongoing clinical issues. More research needs to be conducted on how to improve transitions of care. Countries with different healthcare models may have other barriers to appropriate follow-up.
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Affiliation(s)
- Kelly Lien
- Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, CAN
| | - Barrett A Grattan
- Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, CAN
| | - Alexandra L Reynard
- Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, CAN
| | - Jocelynn Peters
- Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, CAN
| | - Jennifer L Parr
- Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, CAN
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Secure Provider-to-Provider Communication With Electronic Health Record Messaging: An Educational Outreach Study. J Healthc Qual 2019; 40:283-291. [PMID: 29280777 DOI: 10.1097/jhq.0000000000000115] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION With increasing electronic health record (EHR) use, providers are talking less with one another. Now, many rely on EHRs, informal emails, or texts, introducing fragmentation and new data security challenges with new communication strategies. We aimed to examine the impact of a physician champion educational outreach intervention to promote electronic provider-to-provider communication in a large academic multispecialty group. METHODS Physician champions provided educational outreach to 16 academic departments, using 10-minute case-based presentations. Online surveys assessed communication preferences and practices. Electronic health record queries counted EHR messaging use before and after intervention. Descriptive statistics compared responses by specialty (z-test). Paired responses with pre-post data were compared using chi-square tests. Time series analysis assessed EHR messaging rates before intervention versus after intervention. RESULTS Five hundred seventeen providers responded to the postoutreach survey. Eighty-six percent were familiar with EHR messaging tool and 78% knew how to use it after intervention. Among practitioner groups, Family Medicine preferred EHR messaging the most (62%). Groups who declined outreach least preferred it (26%). Among 88 respondents with paired pre-post intervention surveys, familiarity rose (79-96%), and self-reported use increased (66-88%). CONCLUSIONS Physician champion educational outreach increased the use of the secure provider-to-provider EHR messaging tool.
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Stillman M, Gustafson K, Fried GW, Fried K, Williams SR. Communication with general practitioners: a survey of spinal cord injury physicians' perspectives. Spinal Cord Ser Cases 2019; 5:44. [PMID: 31632703 PMCID: PMC6786350 DOI: 10.1038/s41394-019-0187-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 04/17/2019] [Accepted: 04/20/2019] [Indexed: 11/11/2022] Open
Abstract
Study design An online questionnaire. Objectives To gauge spinal cord injury (SCI) specialists' assessment of their communications with general practitioners (GPs). To determine whether economic or health-care system-related factors enhance or inhibit such communication. Setting A collaboration of co-authors from a health-care system. Methods An online survey interrogating a number of aspects of communication between SCI specialists and GPs was developed, distributed, and made available for 4 months. Responses were analyzed for the entire cohort then according to descriptions of participants' home nations' economies and the type of health-care delivery systems in which they work. Results A total of 88 responses were submitted. The majority (64%) were from nations with developed economies, a plurality (47.1%) were from countries that offer universal health coverage, and half used a combination of paper and electronic health records. A majority of respondents (61.8%) reported routinely communicating with their patients' GPs, but most (53.4%) rated those communications as only "fair". The most commonly listed barriers to communication with GPs were lack of time (46.3%) and a perceived lack of receptivity by GPs (26.9%). Nearly all respondents (91.6%) believed that the care they provide would be enhanced by improved communication with GPs. Participants who used electronic means of communication were more likely to communicate with GPs and to describe those interactions as "positive". Conclusions Although there are a number of barriers to communication between SCI specialists and GPs, most SCI specialists are eager for such inter-physician communication and believe it would enhance their care they deliver.
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Affiliation(s)
- Michael Stillman
- Internal Medicine and Rehabilitation Medicine, Sidney Kimmel Medical College of Thomas Jefferson University, 1100 Walnut Street, Suite 601, Philadelphia, PA 19107 USA
- Department of Rehabilitation Medicine, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA USA
| | - Kristin Gustafson
- Department of Rehabilitation Medicine, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA USA
| | - Guy W. Fried
- Senior Vice President for Medical Affairs and Chief Medical Office, Magee Rehabilitation Hospital, Department of Rehabilitation Medicine, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA USA
| | - Karen Fried
- Magee Outpatient Physician Practice Clinic, Magee Rehabilitation Hospital, Philadelphia, PA USA
| | - Steve R. Williams
- Department of Rehabilitation Medicine, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA USA
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Santana MJ, Holroyd-Leduc J, Southern DA, Flemons WW, O'Beirne M, Hill MD, Forster AJ, White DE, Ghali WA. A randomised controlled trial assessing the efficacy of an electronic discharge communication tool for preventing death or hospital readmission. BMJ Qual Saf 2017; 26:993-1003. [PMID: 28821597 DOI: 10.1136/bmjqs-2017-006635] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 06/09/2017] [Accepted: 06/17/2017] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To assess the efficacy of an electronic discharge communication tool (e-DCT) for preventing death or hospital readmission, as well as reducing patient-reported adverse events after hospital discharge. The e-DCT assessed has already been shown to yield high-quality discharge summaries with high levels of patient and physician satisfaction. METHODS This two-arm randomised controlled trial was conducted in a Canadian tertiary care centre's internal medicine medical teaching units. Out of the 1953 patients approached and screened for inclusion, 1399 were randomised and available for data linkage for determination of the primary outcome. Participants were randomly assigned to e-DCT versus usual care (traditional discharge communication generated by dictation). The primary outcome was a composite of death or readmission within 90 days. The secondary outcome included any patient-reported adverse events within 30 days of discharge. RESULTS Among 1399 randomised participants, 230 of 701 participants (32.8%) in the e-DCT group experienced the primary composite outcome of death or readmission within 90 days vs 205 of 698 participants (29.4%) in the usual care group (p=0.166). The incidence at 30 days of patient-reported adverse outcomes (35% for e-DCT vs 34% for usual care) and adverse events (2.1% for e-DCT vs 1.8% for usual care) also did not differ significantly between groups. CONCLUSIONS The e-DCT tested did not reduce the composite endpoint of death or readmission at 90 days, nor the incidence of patient-reported adverse events at 30 days. This neutral finding for hard clinical endpoints needs to be considered in the context of high patient and physician satisfaction, and high quality of discharge summaries.
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Affiliation(s)
- Maria J Santana
- Department of Community Health Sciences, O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jayna Holroyd-Leduc
- Department of Community Health Sciences, O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Danielle A Southern
- Department of Community Health Sciences, O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Ward W Flemons
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Maeve O'Beirne
- Department of Family Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Michael D Hill
- Department of Community Health Sciences, O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Alan J Forster
- Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Deborah E White
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
| | - William A Ghali
- Departments of Community Health Sciences and Medicine, and the Calgary Institute for Population and Public Health, University of Calgary, Calgary, Alberta, Canada
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Atzema CL, Maclagan LC. The Transition of Care Between Emergency Department and Primary Care: A Scoping Study. Acad Emerg Med 2017; 24:201-215. [PMID: 27797435 DOI: 10.1111/acem.13125] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 09/16/2016] [Accepted: 10/19/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Patients with chronic diseases are often forced to seek emergency care for exacerbations. In the face of large predicted increases in the prevalence of chronic diseases, there is increased pressure to avoid hospitalizing these patients at the end of the ED visit, if they can obtain the care they need in the outpatient setting. We performed this scoping study to provide a broad overview of the published literature on the transition of care between ED and primary care following ED discharge. METHODS We performed a MEDLINE search of English-language articles published between 1990 and March 2015. We created a data-charting form a priori of the search. Papers were organized into themes, with new themes created when none of the existing themes matched the paper. Papers with multiple themes were assigned preferentially to the theme that was consistent with their primary objectives. We created a descriptive numerical summary of the included studies. RESULTS Of 1,138 titles, there were 252 potentially relevant abstracts, and among those 122 met criteria for full paper review. An additional 11 papers were acquired from reference review. From the 133 papers, 85 were included in the study. The papers were categorized into seven themes. These included Follow-up compliance and its predictors (38 studies), Telephone calls to discharged ED patients (15 studies), ED navigators (14 studies), The current system (nine studies), Ways to alert primary care providers (PCPs) of the ED visit (seven studies), and Patient views and PCP information requirements (one each). In the Follow-up compliance and predictors theme, the two most frequently identified significant predictors for increasing the frequency of follow-up care were the provision of a follow-up appointment time prior to ED departure and the presence of health insurance. Follow-up telephone calls to patients resulted in better follow-up rates, but increased ED return visits in some studies. In the current system patients themselves are the conduit, and the barriers to follow-up care can be high. E-mail and/or electronic medical record alerts to the PCP are relatively new, and no studies limited the alerts to patients who had a defined need for follow-up care. CONCLUSIONS A plethora of work has been published on the transition of care from ED to primary care. To decrease hospitalizations among the upcoming wave of patients with chronic diseases, it appears that the two most efficient areas to target are a primary care follow-up appointment system and health insurance. Further research is needed in particular to identify the patients who actually need follow-up care and to develop information technology solutions that can be effectively implemented within the current emergency healthcare system.
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Affiliation(s)
- Clare L. Atzema
- Institute for Clinical Evaluative Sciences University of Toronto Toronto ON Canada
- Division of Emergency Medicine University of Toronto Toronto ON Canada
- Department of Medicine University of Toronto Toronto ON Canada
- Sunnybrook Health Sciences Centre Toronto ON Canada
- Institute of Health Policy Management and Evaluation at the University of Toronto Toronto ON Canada
| | - Laura C. Maclagan
- Institute for Clinical Evaluative Sciences University of Toronto Toronto ON Canada
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Brener SS, Bronksill SE, Comrie R, Huang A, Bell CM. Association between in-hospital supportive visits by primary care physicians and patient outcomes: A population-based cohort study. J Hosp Med 2016; 11:418-24. [PMID: 26914153 DOI: 10.1002/jhm.2561] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 01/20/2016] [Accepted: 01/25/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND One long-standing method for continuity of care as patients transition between the hospital and community are supportive visits by primary care physicians during hospitalization. METHODS This retrospective cohort study used administrative data of adults hospitalized from 2008 to 2009 and primary care physicians who conduct supportive visits. Patients who received a visit from their primary care physician while hospitalized were compared to those who did not. Composite outcomes of death, emergency department visit, or emergent readmission within 30 and 90 days were assessed. Postdischarge home-care utilization and primary care physician visits were also examined. Multivariate logistic regression models adjusted for age, sex, low income, rurality, and readmission risk. RESULTS Of the 164,059 patients linked to 3236 primary care physicians, 12.0% received visits while hospitalized. Visited patients had more readmissions, more deaths, and fewer emergency department visits than patients who did not. However, after adjusting, visited patients had a lower risk for the composite outcome at 30 days (adjusted OR [aOR]: 0.92; 95% confidence interval [CI]: 0.89-0.96) and 90 days (aOR: 0.90; 95% CI: 0.87-0.92). Visited patients were also more likely to access community primary care-provider visits and more home-care services. The in-hospital visit resulted in an increased likelihood of health services utilization at 30 days (aOR: 1.16; 95% CI: 1.11-1.22) and 90 days (aOR: 1.20; 95% CI: 1.12-1.27). CONCLUSION A hospital supportive-care visit from a primary care physician resulted in lower risks of adverse patient outcomes and increased access to community health services. Journal of Hospital Medicine 2016;11:418-424. © 2016 Society of Hospital Medicine.
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Affiliation(s)
- Stacey S Brener
- Institute of Health Policy Management & Evaluation, University of Toronto, Toronto, Canada
| | - Susan E Bronksill
- Institute of Health Policy Management & Evaluation, University of Toronto, Toronto, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Canada
| | | | - Anjie Huang
- Institute of Health Policy Management & Evaluation, University of Toronto, Toronto, Canada
| | - Chaim M Bell
- Institute of Health Policy Management & Evaluation, University of Toronto, Toronto, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Canada
- Department of Medicine, University of Toronto and Mount Sinai Hospital, Toronto, Canada
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Santana MJ, Holroyd-Leduc J, Flemons WW, O'Beirne M, White D, Clayden N, Forster AJ, Ghali WA. The seamless transfer of care: a pilot study assessing the usability of an electronic transfer of care communication tool. Am J Med Qual 2013; 29:476-83. [PMID: 24052455 DOI: 10.1177/1062860613503982] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The purpose of this pilot study was to explore the feasibility of implementing a new electronic transfer of care (TOC) tool. The study was conducted in a Canadian tertiary care center. Brief survey instruments were completed by acute care physicians, community-based physicians, and patients to assess providers' perspectives on the usability of the novel electronic tool. The units of analysis were physician and patient perceptions. Mixed methods were used including descriptive statistical analyses and qualitative thematic analysis. Twenty-eight unique acute care physicians completed 100 electronic TOC summaries, and 44 unique community-based physicians rated quality and pertinence of the summaries. Twenty-two patients responded to a follow-up telephone call. The novel TOC communication tool was generally well received by physicians and patients, and it is now being evaluated in a large-scale clinical trial assessing hard clinical outcomes. The information presented herein provides a template for assessment of such information system innovations.
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Hesselink G, Schoonhoven L, Plas M, Wollersheim H, Vernooij-Dassen M. Quality and safety of hospital discharge: a study on experiences and perceptions of patients, relatives and care providers. Int J Qual Health Care 2012. [PMID: 23184652 DOI: 10.1093/intqhc/mzs066] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To identify barriers experienced and perceived at discharge by physicians, nurses, patients and relatives. DESIGN We developed questionnaires based on focus group interviews with hospital and community care providers, and individual interviews with patients and relatives. A survey was conducted among patients, relatives and related nurses and physicians from hospital and community care. SETTING One university hospital and the related community care area in the Netherlands. PARTICIPANTS Thirty health-care providers and eight patients and/or relatives participated in focus group and individual interviews. Questionnaires were returned by 344 health-care providers and 206 patients and relatives. RESULTS Information from the hospital to community care is often incomplete, unclear and delayed. Especially hospital physicians (52%) and general practitioners (GPs; 63%) experience the quality of information exchanged from the hospital to the GP as poor. Coordination of care is often frustrated by a lack of care provider knowledge and collaboration. Hospital physicians (47%) and GPs (71%) feel that hospital physicians are often not sufficiently aware of the patient's home situation. Respectively, 59 and 81% experience that the GP is often not clearly informed about expected tasks and responsibilities at discharge. CONCLUSIONS This is the first study that provides a clear picture of the experiences and perceptions of stakeholders regarding handovers at hospital discharge. Lack of knowledge, understanding and interest between hospital and community care providers are important causes for ineffective and unsafe discharge. The study suggests that improvement efforts should be focused more on these aspects, as primary conditions for improving hospital discharge.
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Affiliation(s)
- Gijs Hesselink
- Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, PO Box 9101, 114 IQ Healthcare, 6500 HB Nijmegen, The Netherlands.
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Okoniewska BM, Santana MJ, Holroyd-Leduc J, Flemons W, O'Beirne M, White D, Clement F, Forster A, Ghali WA. The Seamless Transfer-of-Care Protocol: a randomized controlled trial assessing the efficacy of an electronic transfer-of-care communication tool. BMC Health Serv Res 2012; 12:414. [PMID: 23170814 PMCID: PMC3529105 DOI: 10.1186/1472-6963-12-414] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Accepted: 10/22/2012] [Indexed: 11/13/2022] Open
Abstract
Background The transition between acute care and community care represents a vulnerable period in health care delivery. The vulnerability of this period has been attributed to changes to patients’ medication regimens during hospitalization, failure to reconcile discrepancies between admission and discharge and the burdening of patients/families to take over care responsibilities at discharge and to relay important information to the primary care physician. Electronic communication platforms can provide an immediate link between acute care and community care physicians (and other community providers), designed to ensure consistent information transfer. This study examines whether a transfer-of-care (TOC) communication tool is efficacious and cost-effective for reducing hospital readmission, adverse events and adverse drug events as well as reducing death. Methods A randomized controlled trial conducted on the Medical Teaching Unit of a Canadian tertiary care centre will evaluate the efficacy and cost-effectiveness of a TOC communication tool. Medical in-patients admitted to the unit will be considered for this study. Data will be collected upon admission, and a total of 1400 patients will be randomized. The control group’s acute care stay will be summarized using a traditional dictated summary, while the intervention group will have a summary generated using the TOC communication tool. The primary outcome will be a composite, at 3 months, of death or readmission to any Alberta acute-care hospital. Secondary outcomes will be the occurrence of post-discharge adverse events and adverse drug events at 1 month post discharge. Patients with adverse outcomes will have their cases reviewed by two Royal College certified internists or College-certified family physicians, blinded to patients’ group assignments, to determine the type, severity, preventability and ameliorability of all detected adverse outcomes. An accompanying economic evaluation will assess the cost per life saved, cost per readmission avoided and cost per QALY gained with the TOC communication tool compared to traditional dictation summaries. Discussion This paper outlines the study protocol for a randomized controlled trial evaluating an electronic transfer-of-care communication tool, with sufficient statistical power to assess the impact of the tool on the significant outcomes of post-discharge death or readmission. The study findings will inform health systems around the world on the potential benefits of such tools, and the value for money associated with their widespread implementation. Trial registration ClinicalTrials.gov NCT01402609.
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Affiliation(s)
- Barbara M Okoniewska
- Department of Community Health Sciences, W21C Research and Innovation Centre, Institute of Public Health, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, Canada.
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Harel Z, Wald R, Perl J, Schwartz D, Bell CM. Evaluation of deficiencies in current discharge summaries for dialysis patients in Canada. J Multidiscip Healthc 2012; 5:77-84. [PMID: 22536078 PMCID: PMC3333802 DOI: 10.2147/jmdh.s27572] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background Deficits in the transfer of information between inpatient and outpatient physicians are common and pose a patient safety risk. This is particularly the case for vulnerable populations such as patients with end-stage renal disease requiring dialysis. These patients have unique and complex health care needs that may not be effectively communicated on standard discharge summaries, which may result in potential medical errors and adverse events. Objective To evaluate Canadian dialysis center directors’ perceptions of deficiencies in the content and quality of hospital discharge summaries for dialysis patients. Methods A web-based, cross-sectional survey of Canadian dialysis center directors was performed between September and November 2010. The survey consisted of three parts. The first part was designed to assess dialysis center directors’ attitudes on the quality of discharge summaries they receive. The second part was designed to elicit respondents’ preferences for discharge summary content, and the third part consisted of questions regarding demographic and practice information. Results Of 79 dialysis center directors, 21 (27%) completed the survey. Sixty-two percent felt that current discharge summaries inadequately communicate dialysis-specific information. Receipt of antibiotics for line sepsis or peritonitis, modifications to vascular access, and changes in target weight/dialysis prescription were rated as essential dialysis-specific information to include in discharge summaries by respondents. Conclusion Over three quarters of dialysis center directors find the current practice of transferring discharge information for hospitalized dialysis patients grossly inadequate. The inclusion of dialysis-specific information may improve the quality of discharge summaries for dialysis patients.
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Affiliation(s)
- Ziv Harel
- Division of Nephrology, St Michael's Hospital, University of Toronto, Toronto, Ontario
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Arora VM, Prochaska ML, Farnan JM, D'Arcy MJ, Schwanz KJ, Vinci LM, Davis AM, Meltzer DO, Johnson JK. Problems after discharge and understanding of communication with their primary care physicians among hospitalized seniors: a mixed methods study. J Hosp Med 2010; 5:385-91. [PMID: 20578045 PMCID: PMC3186075 DOI: 10.1002/jhm.668] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Communication and coordination with primary care physicians (PCPs) is recommended to ensure safe care transitions for hospitalized older patients. Understanding patient experiences of problems after discharge can help clinical teams design more patient-centered care transitions. OBJECTIVE To report older patients' experiences with problems after hospital discharge and investigate whether PCPs were aware of their hospitalization. DESIGN Prospective mixed methods study. SETTING Single academic medical center. PATIENTS Hospitalized patients and PCPs. MEASUREMENTS Telephone interviews of frail, older general medical patients conducted 2 weeks after discharge to elicit patient problems after discharge, such as: (1) obtaining medications, or follow-up appointments; and (2) perceptions of hospital physician communication with their PCP. For each patient interviewed, their PCP was faxed a survey 2 weeks after discharge to assess awareness of hospitalization. RESULTS Forty-two percent (27) of patients reported 42 different post-discharge problems. The most frequently reported problems were difficulty with follow-up appointments or tests (12). Other reported problems included readmission and return to the Emergency Department (10), problems with medications (8), not-prepared for discharge (8), and hospital complications or questions (4). Thirty percent of PCPs were unaware of patient hospitalization. Patients were twice as likely to report a problem if their PCP was unaware of the hospitalization (31% PCP aware, vs. 67% PCP not aware; P < 0.05). CONCLUSION This study suggests that many frail, older patients reported problems after discharge and were twice as likely to do so when the patient's PCP was not aware of the hospitalization. Systematic interventions to improve communication with PCPs during patient hospitalization are needed.
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Affiliation(s)
- Vineet M Arora
- Department of Medicine, University of Chicago, Chicago, Illinois 60637, USA.
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12
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van Walraven C, Taljaard M, Bell CM, Etchells E, Zarnke KB, Stiell IG, Forster AJ. Information exchange among physicians caring for the same patient in the community. CMAJ 2008; 179:1013-8. [PMID: 18981442 DOI: 10.1503/cmaj.080430] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND The exchange of information is an integral component of continuity of health care and may limit or prevent costly duplication of tests and treatments. This study determined the probability that patient information from previous visits with other physicians was available for a current physician visit. METHODS We conducted a multicentre prospective cohort study including patients discharged from the medical or surgical services of 11 community and academic hospitals in Ontario. Patients included in the study saw at least 2 different physicians during the 6 months after discharge. The primary outcome was whether information from a previous visit with another physician was available at the current visit. We determined the availability of previous information using surveys of or interviews with the physicians seen during current visits. RESULTS A total of 3250 patients, with a total of 39 469 previous-current visit combinations, met the inclusion criteria. Overall, information about the previous visit was available 22.0% of the time. Information was more likely to be available if the current doctor was a family physician (odds ratio [OR] 1.75, 95% confidence interval [CI] 1.54-1.98) or a physician who had treated the patient before the hospital admission (OR 1.33, 95% CI 1.21-1.46). Conversely, information was less likely to be available if the previous doctor was a family physician (OR 0.38, 95% CI 0.32-0.44) or a physician who had treated the patient before the admission (OR 0.72, 95% CI 0.60-0.86). The strongest predictor of information exchange was the current physician having previously received information about the patient from the previous physician (OR 7.72, 95% CI 6.92-8.63). INTERPRETATION Health care information is often not shared among multiple physicians treating the same patient. This situation would be improved if information from family physicians and patients' regular physicians was more systematically available to other physicians.
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Affiliation(s)
- Carl van Walraven
- Clinical Epidemiology Program, Ottawa Health Research Institute, ASB1-003, Ottawa Hospital, Civic Campus, 1053 Carling Ave., Ottawa, ONK1Y4E9.
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Afilalo M, Lang E, Léger R, Xue X, Colacone A, Soucy N, Vandal A, Boivin JF, Unger B. Impact of a standardized communication system on continuity of care between family physicians and the emergency department. CAN J EMERG MED 2007; 9:79-86. [PMID: 17391577 DOI: 10.1017/s1481803500014834] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE It has been suggested that continuity of care is hampered because of the lack of communication between emergency departments (EDs) and primary care providers. A web-based, standardized communication system (SCS) that enables family physicians (FPs) to visualize information regarding their patients' ED visits was developed. This paper aims to evaluate the impact of this SCS on continuity of care. METHODS We conducted an open, 4-period crossover, cluster-randomized controlled trial of 23 FP practices. During the intervention phase, FPs received detailed reports via SCS, while in the control phase they received mailed copies of the ED notes. Continuity of care was evaluated with a web questionnaire completed by FPs 21 days after the ED visit. The primary measures of continuity of care were knowledge of ED visit (quality and quantity), patient management and follow-up rate. RESULTS We analyzed a total of 2022 ED visits (1048 intervention and 974 control). The intervention group received information regarding the ED visit more often (odds ratio [OR] 3.14, 95% confidence interval [CI] 2.6-3.79), found the information more useful (OR 5.1, 95% CI 3.49-7.46), possessed a better knowledge of the ED visit (OR 6.28, 95% CI 5.12-7.71), felt they could better manage patients (OR 2.46, 95% CI 2.02-2.99) and initiated actions more often following receipt of information (OR 1.62, 95% CI 1.36-1.93). However, there was no significant difference in the follow-up rate at FPs offices (OR 1.25, 95% CI 0.97-1.61). CONCLUSION The use of SCS between an ED and FPs led to significant improvements in continuity of care by increasing the usefulness of transferred information and by improving FPs' perceived patient knowledge and patient management.
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Affiliation(s)
- Marc Afilalo
- Emergency Department, Emergency Multidisciplinary Research Unit, Sir Mortimer B. Davis-Jewish General Hospital, Montréal, Québec, Canada.
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Abstract
The emergency department intershift transfer of patient care is a universal event. Despite the frequency of its occurrence and complexity of issues surrounding the exchange, emergency department patient handover is insufficiently explored in our literature. This article reviews the effectiveness and efficiencies of the handover practice. The authors provide personal opinion regarding favorable parameters for the prehandover, intershift meeting, and posthandover activities.
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Affiliation(s)
- Jonathan I Singer
- Department of Emergency Medicine, Wright State University School of Medicine, Dayton, OH 45429, USA.
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Lang E, Afilalo M, Vandal AC, Boivin JF, Xue X, Colacone A, Léger R, Shrier I, Rosenthal S. Impact of an electronic link between the emergency department and family physicians: a randomized controlled trial. CMAJ 2006; 174:313-8. [PMID: 16399880 PMCID: PMC1373712 DOI: 10.1503/cmaj.050698] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Electronic information exchange is believed to improve efficiency and reduce resource utilization. We developed a Web-based standardized communication system (SCS) that enables family physicians to receive detailed reports of their patients' care in the emergency department. We sought to determine the impact of the SCS on measures of resource utilization in the emergency department and family physician offices. METHODS We used an open 4-period crossover cluster-randomized controlled design. During 2 separate 10-week intervention phases, family physicians received detailed reports of their patients' emergency department visits over the Internet, and in the alternating control phases they received a 1-page copy of the emergency department notes by mail. The primary outcome was the number of repeat visits to the emergency department within 14 days of the initial visit. Secondary outcomes included duplication of test and specialty consultation requests by the emergency and family physician. Outcomes were measured using the hospital database and questionnaires sent to the family physicians. RESULTS A total of 2022 patient visits to the emergency department from 23 practices were used in the study. Use of the SCS failed to reduce the number of repeat visits to the emergency department within 14 days (odds ratio [OR] 1.10, 95% confidence interval [CI] 0.8-1.51) and 28 days (OR 1.01, 95% CI 0.8-1.27). There was no significant duplication of requests for diagnostic tests between the emergency and family physician during the intervention and control phases (24 v. 22, p = 0.93), but there was significantly greater duplication in specialty consultation requests in the intervention phase than in the control phase (20 v. 8, p = 0.049). INTERPRETATION An electronic link between emergency and family physicians did not result in a significant reduction in resource utilization at either service point. Investments in improved electronic information exchange between emergency departments and family physician offices may not be substantiated by a reduction in resource utilization.
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Affiliation(s)
- Eddy Lang
- Emergency Department, Emergency Multidisciplinary Research Unit, Sir Mortimer B. Davis-Jewish General Hospital, McGill University, Montréal, Qué.
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