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Waeschle RM, Epperlein T, Demmer I, Hummers E, Quintel Q. Intersectoral cooperation between university hospitals and physicians in private practice in Germany- where the potential for optimization lies. BMC Health Serv Res 2024; 24:497. [PMID: 38649877 PMCID: PMC11034040 DOI: 10.1186/s12913-024-10963-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 04/08/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Intersectoral cooperation between physicians in private practice and hospitals is highly relevant for ensuring the quality of medical care. However, the experiences and potential for optimization at this interface from the perspective of physicians in private practice have not yet been systematically investigated. The aim of this questionnaire survey was to record participants' experiences with regard to cooperation with university hospitals and to identify the potential for optimizing intersectoral cooperation. METHODS We performed a prospective cross-sectional study using an online survey among practising physicians of all disciplines offering ambulatory care in Germany. The link to a 41-item questionnaire was sent via mail using a commercial mail distributor in which 1095 practising physicians participated. Baseline statistics were performed with SurveyMonkey and Excel. RESULTS A total of 70.6%/722 of the responding physicians in private practice rated cooperation with university hospitals as satisfactory. Satisfaction with the quality of treatment was confirmed by 87.2%/956 of the physicians. The subjectively perceived complication rate in patient care was assessed as rare (80.9%/886). However, the median waiting time for patients in the inpatient discharge letter was 4 weeks. The accessibility of medical contact persons was rated as rather difficult by 52.6%/577 of the physicians. A total of 48.6%/629 of the participants considered better communication as an equal partner to be an important potential for optimization. Likewise, 65.2%/714 participants wished for closer cooperation in pre- and/or post inpatient care. CONCLUSION The following optimization potentials were identified: timely discharge letters, clear online presentations of clinical contacts, improved accessibility by telephone, introduction or further development of a referral portal, regular intersectoral training and/or "get-togethers", regular surveys of general practitioners and implementation of resulting measures, further development of cross-sectoral communication channels and strengthening of hospital IT.
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Affiliation(s)
- R M Waeschle
- Department of Anaesthesiology, University Medical Centre Göttingen, Robert-Koch-Str. 40, 37099, Göttingen, Germany.
| | - T Epperlein
- Department of Anaesthesiology, University Medical Centre Göttingen, Robert-Koch-Str. 40, 37099, Göttingen, Germany
| | - I Demmer
- Department of General Practice, University Medical Centre Göttingen, Göttingen, Germany
| | - E Hummers
- Department of General Practice, University Medical Centre Göttingen, Göttingen, Germany
| | - Q Quintel
- Department of Anaesthesiology, University Medical Centre Göttingen, Robert-Koch-Str. 40, 37099, Göttingen, Germany
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Gusmeroli M, Perks S, Lanskey C, Bates N. Australian general practitioners' views on qualities that make effective discharge communication: a scoping review. Aust J Prim Health 2023; 29:405-415. [PMID: 37258408 DOI: 10.1071/py22231] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 05/08/2023] [Indexed: 06/02/2023]
Abstract
Transitions of patient care between hospital discharge and primary care are known to be an area of high-risk where communication is imperative for patient safety. Discharge summaries are known to often be incomplete, delayed and unhelpful for community healthcare providers. The aim of this review was to identify and map the literature which discusses Australian general practitioners' (GPs) views on the qualities that make up effective discharge communication. Medline, Scopus and the Cochrane register of controlled drug trails and systematic reviews were searched for publications until October 2021 that discussed Australian GPs' views on discharge communication from hospital to general practice. Of 1696 articles identified, 18 met inclusion and critical appraisal criteria. Five studies identified that GPs view timeliness of discharge summary receipt to be a problem. Communication of medication information in the discharge summary was discussed in six studies, with two reporting that GPs view reasons for medication changes to be essential. Five studies noted GPs would prefer to receive clinical discipline or diagnosis specific information. Four studies identified that GPs viewed the format and readability of discharge summaries to be problematic, with difficulties finding salient information. The findings of this scoping review indicate that GPs view timeliness, completeness, readability, medication related information and diagnosis/clinical discipline specific information to be qualities that make up effective discharge communication from hospital to the community. There are opportunities for further research in perspectives of effective discharge communication, and future studies on interventions to improve discharge communication, patient safety and policy in transfers of care.
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Affiliation(s)
- Melinda Gusmeroli
- Townsville University Hospital, Townsville, Qld 4814, Australia; and James Cook University, Townsville, Qld 4814, Australia
| | - Stephen Perks
- Townsville University Hospital, Townsville, Qld 4814, Australia; and James Cook University, Townsville, Qld 4814, Australia
| | - Cassie Lanskey
- Townsville University Hospital, Townsville, Qld 4814, Australia; and James Cook University, Townsville, Qld 4814, Australia
| | - Nicole Bates
- Townsville University Hospital, Townsville, Qld 4814, Australia
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Douplat M, Daoud K, Berthiller J, Schott AM, Potinet V, Le Coz P, Tazarourte K, Jacquin L. Poor Involvement of General Practitioners in Decisions of Withholding or Withdrawing Life-Sustaining Treatment in Emergency Departments. J Gen Intern Med 2020; 35:177-181. [PMID: 31686289 PMCID: PMC6957665 DOI: 10.1007/s11606-019-05464-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 09/30/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Decisions of withholding or withdrawing life-sustaining treatment are frequent in emergency departments (ED) and patients are often unable to communicate their wishes concerning end of life desires. OBJECTIVE To evaluate the participation of general practitioners (GPs) during the decision-making process of withholding or withdrawing life-sustaining treatments in ED. DESIGN Prospective observational multicenter study. PATIENTS We included patients for whom a decision of withdrawing or withholding life-sustaining treatments was made in ED. For each patient, we enrolled one general practitioner. MAIN MEASURES GPs were interviewed about their perception of end of life patient's management and the communication with ED and families. KEY RESULTS There were 109 potential patient participants. We obtained answers from 54 (49.5%) of the patient's associated GPs. Only 4 (7.4%) GPs were involved during the decision-making process of withholding or withdrawing life-sustaining treatments. Among GPs, 29 (53.7%) were contacted by family after the decision, most often to talk about their difficult experience with the decision. A majority (94%) believed their involvements in these decisions were important and 68% wished to "always" participate in end of life decisions despite the fact that they usually don't participate in these decisions. Finally, 66% of GPs believed that management of end of life in the emergency department was a failure and should be anticipated. CONCLUSIONS GPs would like to be more involved and barriers to GP involvement need to be overcome. We do not have any outcome data to suggest that routine involvement of GPs in all end of life patients improves their outcomes. Moreover, it requires major system and process-based changes to involve all primary care physicians in ED decision-making. NIH TRIAL REGISTRY NUMBER NCT02844972.
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Affiliation(s)
- Marion Douplat
- Hospices Civils de Lyon, Hôpital Lyon Sud, Service d’Accueil des urgences, 165 chemin du Grand Revoyet, F-69495 Pierre Bénite, France
- Aix-Marseille Université/EFS/CNRS, UMR 7268 ADéS, Faculté de Médecine, 27 Boulevard Jean Moulin, 13005 Marseille, France
| | - Khadidja Daoud
- Hôpital de Vienne, Service d’Accueil des urgences, Montée du Dr Chapuis, 38209 Vienne, France
| | - Julien Berthiller
- Pôle Information Médicale Evaluation Recherche, Hospices Civils de Lyon/University Claude Bernard Lyon 1 /HESPER EA 7425, Lyon, France
| | - Anne-Marie Schott
- Pôle Information Médicale Evaluation Recherche, Hospices Civils de Lyon/University Claude Bernard Lyon 1 /HESPER EA 7425, Lyon, France
| | - Véronique Potinet
- Hospices Civils de Lyon, Hôpital Lyon Sud, Service d’Accueil des urgences, 165 chemin du Grand Revoyet, F-69495 Pierre Bénite, France
| | - Pierre Le Coz
- Aix-Marseille Université/EFS/CNRS, UMR 7268 ADéS, Faculté de Médecine, 27 Boulevard Jean Moulin, 13005 Marseille, France
| | - Karim Tazarourte
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service d’Accueil des urgences, 5 place d’Arsonval, F-69003 Lyon, France
| | - Laurent Jacquin
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service d’Accueil des urgences, 5 place d’Arsonval, F-69003 Lyon, France
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Douplat M, Berthiller J, Schott AM, Potinet V, Le Coz P, Tazarourte K, Jacquin L. Difficulty of the decision-making process in emergency departments for end-of-life patients. J Eval Clin Pract 2019; 25:1193-1199. [PMID: 31287201 DOI: 10.1111/jep.13229] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 06/17/2019] [Accepted: 06/19/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND In emergency departments, for some patients, death is preceded by a decision of withholding or withdrawing life-sustaining treatments. This concerns mainly patients over 80, with many comorbidities. The decision-making process of these decisions in emergency departments has not been extensively studied, especially for noncommunicating patients. AIM The purpose of this study is to describe the decision-making process of withholding and withdrawing life-sustaining treatments in emergency departments for noncommunicating patients and the outcome of said patients. DESIGN We conducted a prospective multicenter study in three emergency departments of university hospitals from September 2015 to January 2017. RESULTS We included 109 patients in the study. Fifty-eight (53.2%) patients were coming from nursing homes and 52 (47.7%) patients had dementia. Decisions of withholding life-sustaining treatment concerned 93 patients (85.3%) and were more frequent when a surrogate decision maker was present 61 (65.6%) versus seven (43.8%) patients. The most relevant factors that lead to these decisions were previous functional limitation (71.6%) and age (69.7%). Decision was taken by two physicians for 80 patients (73.4%). The nursing staff and general practitioner were, respectively, involved in 31 (28.4%) and two (1.8%) patients. A majority of the patients had no advance directives (89.9%), and the relatives were implicated in the decision-making process for 96 patients (88.1%). Death in emergency departments occurred for 47 patients (43.1%), and after 21 days, 84 patients (77.1 %) died. CONCLUSION There is little anticipation in end-of-life decisions. Discussion with patients concerning their end-of-life wishes and the writing of advance directives, especially for patients with chronic diseases, must be encouraged early.
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Affiliation(s)
- Marion Douplat
- Hospices Civils de Lyon, Service d'Accueil des urgences, Hôpital Lyon Sud, 165 chemin du Grand Revoyet, Pierre Bénite, F-69495, France.,UMR 7268 ADéS, Faculté de Médecine, Aix-Marseille Université/EFS/CNRS, 27 boulevard Jean Moulin, Marseille, 13005, France
| | - Julien Berthiller
- Pôle Information Médicale Evaluation Recherche, Hospices Civils de Lyon, Lyon, France
| | - Anne-Marie Schott
- Pôle Information Médicale Evaluation Recherche, Hospices Civils de Lyon, Lyon, France
| | - Véronique Potinet
- Hospices Civils de Lyon, Service d'Accueil des urgences, Hôpital Lyon Sud, 165 chemin du Grand Revoyet, Pierre Bénite, F-69495, France
| | - Pierre Le Coz
- UMR 7268 ADéS, Faculté de Médecine, Aix-Marseille Université/EFS/CNRS, 27 boulevard Jean Moulin, Marseille, 13005, France
| | - Karim Tazarourte
- Hospices Civiles de Lyon, Hôpital Edouard Herriot, Service d'Accueil des urgences, 5 place d'Arsonval, Lyon, F-69003, France
| | - Laurent Jacquin
- Hospices Civiles de Lyon, Hôpital Edouard Herriot, Service d'Accueil des urgences, 5 place d'Arsonval, Lyon, F-69003, France
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Karam M, Tricas-Sauras S, Darras E, Macq J. Interprofessional Collaboration between General Physicians and Emergency Department Teams in Belgium: A Qualitative Study. Int J Integr Care 2017; 17:9. [PMID: 29588632 PMCID: PMC5853879 DOI: 10.5334/ijic.2520] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 08/23/2017] [Indexed: 11/28/2022] Open
Abstract
This study aimed to assess interprofessional collaboration between general physicians and emergency departments in the French speaking regions of Belgium. Eight group interviews were conducted both in rural and urban areas, including in Brussels. Findings showed that the relational components of collaboration, which are highly valued by individuals involved, comprise mutual acquaintanceship and trust, shared power and objectives. The organizational components of collaboration included out-of-hours services, role clarification, leadership and overall environment. Communication and patient's role were also found to be key elements in enhancing or hindering collaboration across these two levels of care. Relationships between general physicians and emergency departments' teams were tightly linked to organizational factors and the general macro-environment. Health system regulation did not appear to play a significant role in promoting collaboration between actors. A better role clarification is needed in order to foster multidisciplinary team coordination for a more efficient patient management. Finally, economic power and private practice impeded interprofessional collaboration between the care teams. In conclusion, many challenges need to be addressed for achievement of a better collaboration and more efficient integration. Not only should integration policies aim at reinforcing the role of general physicians as gatekeepers, also they should target patients' awareness and empowerment.
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Almidani E, Qudair A, Khadawardi E, Alshareef T, Shoura S, Alobari R, Alhajjar S, Almofada S. Challenges of implementing a standardized process for discharge summaries (5 years experience). Int J Pediatr Adolesc Med 2017; 4:115-118. [PMID: 30805513 PMCID: PMC6372491 DOI: 10.1016/j.ijpam.2017.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Revised: 05/10/2017] [Accepted: 06/06/2017] [Indexed: 11/28/2022]
Abstract
Introduction Discharge summaries are essential documents to provide a long-lasting record of a patient's visit to a hospital. It provides an effective method of communication between various hospital services and primary care providers. We conducted a study recently in KFSH&RC recommending that every admitted patient to the Pediatric Department must have a discharge summary initiated as soon as possible within the first five days of hospitalization and to be updated periodically until its completion on the patient's discharge day. Results of this study showed that most of the patients received their discharge summaries within the time limit as recommended by the JCIA standard. Objectives The aim of this paper is to present our department's experience in regard to the difficulties, challenges, and outcomes of the adopted work flow for discharge summaries over a period of five years. Methods The residents have been instructed to initiate the discharge summaries as soon as possible within the first five days of hospitalization for every patient admitted under the Department of Pediatrics regardless of the expected discharge date. Afterward, it will be the responsibility of the attending junior and senior residents to update the summaries on regular basis as long as the patient under their care. They should transfer the updated summary to the coming resident that will take over the medical care until the discharge day when the most recent update will be forwarded to the attending consultant for final review and signature. Results Between 2011 and 2016, a significant drop in the number of delinquent records was noted. From 1131 delinquent records at the end of the fourth quarter of 2011, the number has fallen to 15 in the fourth quarter of 2016. Furthermore, compliance to JCIA documentation standards showed sustained improvement since the initiation of the project. The department used to score around 50% in the discharge documentation compliance rate which has improved to be maintained around 80%s in average. Conclusions Every new project concerning the quality of patient care provided in any institution is expected to face multiple challenges and difficulties. Proper identifications of the challenges, standardize approach for solutions, sustainability of quality monitoring for an improvement projects can maintain the success for any new project.
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Affiliation(s)
- Eyad Almidani
- Department of Pediatrics, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Ahmad Qudair
- Department of Pediatrics, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Emad Khadawardi
- Department of Pediatrics, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Turki Alshareef
- Department of Pediatrics, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | | | - Rania Alobari
- Quality Management Department, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Sami Alhajjar
- Department of Pediatrics, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Saleh Almofada
- Medical and Clinical Affairs, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
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Wimsett J, Harper A, Jones P. Review article: Components of a good quality discharge summary: a systematic review. Emerg Med Australas 2014; 26:430-8. [PMID: 25186466 DOI: 10.1111/1742-6723.12285] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The present study aims to inform the use of discharge summaries as a marker of the quality of communication between ED and primary care; this systematic review aims to identify a consensus on the key components of a high-quality discharge summary. METHOD A systematic search of the major medical and allied health databases and Google Scholar was conducted, using predetermined criteria for inclusion. Two authors independently reviewed the full texts of potentially relevant studies to determine eligibility for inclusion. Data were extracted using a standard form, and the level of evidence was assessed using a predetermined scale. RESULTS We screened 827 articles, and 84 articles underwent full-text review. Thirty-two studies were included, and 15 studies were level A or B studies. The agreement between authors for level of evidence was good: k = 0.62 (95% confidence interval [CI] 0.4-0.84) and for which components were included was 1011/1056, 95.7% (95% CI 94.3-96.8%). Thirty-four components were identified; however, only four were ranked as important by ≥80% of respondents or scored ≥80% on a scale of importance. These were: discharge diagnosis, treatment received, investigation results and follow-up plan. The quality of information contained in summaries was incompletely assessed in most studies. CONCLUSION The key components to include in a discharge summary are the discharge diagnosis, treatment received, results of investigations and the follow up required. The limited evidence pertaining to ED discharges was consistent with this. The adequacy of the components rather than just their presence or absence should also be considered when assessing the quality of discharge summaries.
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Affiliation(s)
- Jordon Wimsett
- Emergency Department, Wellington Hospital, Wellington, New Zealand
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Cox W, Price R. What general practitioners require of diagnostic imaging departments: A case study. Radiography (Lond) 2014. [DOI: 10.1016/j.radi.2013.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Etesse B, Jaber S, Mura T, Leone M, Constantin JM, Michelet P, Zoric L, Capdevila X, Malavielle F, Allaouchiche B, Orban JC, Fabbro-Peray P, Lefrant JY. How the relationships between general practitioners and intensivists can be improved: the general practitioners' point of view. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2010; 14:R112. [PMID: 20546560 PMCID: PMC2911758 DOI: 10.1186/cc9061] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/28/2009] [Revised: 12/20/2009] [Accepted: 06/14/2010] [Indexed: 11/29/2022]
Abstract
Introduction The present study assessed the opinion of general practitioners (GPs) concerning their relationships with intensivists. Methods An anonymous questionnaire was mailed to 7,239 GPs. GPs were asked about their professional activities, postgraduate intensive care unit (ICU) training, the rate of patient admittance to ICUs, and their relationships with intensivists. Relationship assessment was performed by using a graduated visual analogue scale (VAS) ranging from 0 (dissatisfaction) to 100 (satisfaction). A multivariate analysis with stepwise logistic regression was performed to isolate factors explaining dissatisfaction (VAS score, < 25th percentile). Results Twenty-two percent of the GPs (1,561) responded. The median satisfaction score was 57 of 100 (interquartile (IQ), 35 to 77]. Five independent factors of dissatisfaction were identified: no information provided to GPs at patient admission (odds ratio (OR) = 2.55 (1.71 to 3.80)); poor quality of family reception in the ICU (OR = 2.06 (1.40 to 3.02)); the ICU's family contact person's identity or function or both is unclear (OR = 1.48 (1.03 to 2.12)), lack of family information (OR = 2.02 (2.48 to 2.75)), and lack of discharge report (OR = 3.39 (1.70 to 6.76)). Three independent factors prevent dissatisfaction: age of GPs ≤45 years (OR = 0.69 (0.51 to 0.94)); the GP is called at patient ICU admission (OR = 0.44 (0.31 to 0.63)); and GP involvement in treatment decisions (OR = 0.17 (0.07 to 0.40)). Conclusions Considerable improvement in GP/intensivist relationships can be achieved through increased communication measures.
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Affiliation(s)
- Bérengère Etesse
- Division Anesthésie Réanimation Douleur Urgences, Groupe Hospitalo-Universitaire Caremeau, Centre Hospitalier Universitaire Nîmes, Place du Professeur Robert Debré, 30029 Nîmes Cedex 9, France.
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