Deficits in communication and information transfer between hospital-based and primary care physicians: implications for patient safety and continuity of care.
BACKGROUND
Delayed or inaccurate communication between hospital-based and primary care physicians at hospital discharge may negatively affect continuity of care and contribute to adverse events.


OBJECTIVE
To characterize the prevalence of deficits in communication and information transfer at hospital discharge and to identify interventions to improve this process.


METHODS
MEDLINE (through November 2006), Cochrane Database of Systematic Reviews, and hand search of article bibliographies.


METHODS
Observational studies investigating communication and information transfer at hospital discharge (n = 55) and controlled studies evaluating the efficacy of interventions to improve information transfer (n = 18).


METHODS
Data from observational studies were extracted on the availability, timeliness, content, and format of discharge communications, as well as primary care physician satisfaction. Results of interventions were summarized by their effect on timeliness, accuracy, completeness, and overall quality of the information transfer.


RESULTS
Direct communication between hospital physicians and primary care physicians occurred infrequently (3%-20%). The availability of a discharge summary at the first postdischarge visit was low (12%-34%) and remained poor at 4 weeks (51%-77%), affecting the quality of care in approximately 25% 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%-63%), treatment or hospital course (7%-22%), discharge medications (2%-40%), test results pending at discharge (65%), patient or family counseling (90%-92%), and follow-up plans (2%-43%). 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.


CONCLUSIONS
Deficits in communication and information transfer at hospital discharge are common and may adversely affect patient care. Interventions such as computer-generated summaries and standardized formats may facilitate more timely transfer of pertinent patient information to primary care physicians and make discharge summaries more consistently available during follow-up care.
Kripalani
Sunil
S
Division of General Medicine, Department of Internal Medicine, Emory University School of Medicine, Atlanta, Ga 30303, USA. skripal@emory.edu
LeFevre
Frank
F
Phillips
Christopher O
CO
Williams
Mark V
MV
Basaviah
Preetha
P
Baker
David W
DW
D000359:Aftercare / Q000592:standards; D003266:Continuity of Patient Care / Q000592:standards*; D020445:Hospitalists; D006801:Humans; D033183:Interdisciplinary Communication; D010351:Patient Discharge; D010821:Physicians, Family; D011787:Quality of Health Care; D014481:United States