Primary care follow up of patients discharged from the emergency department: a retrospective study.
BACKGROUND
The visit to the emergency department (ED) constitutes a brief, yet an important point in the continuum of medical care. The aim of our study was to evaluate the continuity of care of adult ED visitors.


METHODS
We retrospectively reviewed all ED discharge summaries for over a month 's period. The ED chart, referral letter and the patient's primary care file were reviewed. Data collected included: age, gender, date and hour of ED visit, documentation of ED referral and ED discharge letter in the primary care file.


RESULTS
359 visits were eligible for the study. 192 (53.5%) of the patients were women, average age 54.1 +/- 18.7 years (mean +/- SD). 214 (59.6%) of the visits were during working hours of primary care clinics ("working hours"), while the rest were "out of hours" visits. Only 196 (54.6%) of patients had a referral letter, usually from their family physician. A third (71/214) of "working hours" visits were self referrals, the rate rose to 63.5% (92/145) of "out of hours" visits (p < 0.0001). The ED discharge letter was found in 50% (179/359) of the primary care files. A follow-up visit was documented in only 31% (111/359). Neither follow up visit nor discharge letter were found in 43% of the files (153/359).


CONCLUSIONS
We have found a high rate of ED self referrals throughout the day together with low documentation rates of ED visits in the primary care charts. Our findings point to a poor continuity of care of ED attendees.
The Department of Family Medicine, Clalit Health Services, Central District, Rishon Lezion, Israel. vinker01@inter.net.il
Shlomo
S
Vinker
Eliezer
E
Kitai
Yaacov
Y
Or
Sasson
S
Nakar
D000328:Adult; D039602:After-Hours Care / Q000706:statistics & numerical data; D000368:Aged; D003151:Community Health Centers / Q000706:statistics & numerical data; D003266:Continuity of Patient Care / Q000592:standards*; D004282:Documentation; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006297:Health Services Accessibility; D006801:Humans; D007557:Israel; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D010351:Patient Discharge / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000706:statistics & numerical data*; D017064:Process Assessment, Health Care; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012189:Retrospective Studies