Dropping the baton during the handoff from emergency department to primary care: pediatric asthma continuity errors.
BACKGROUND
The handoff of patient care from emergent to primary care physicians (PCPs) has been associated with critical safety problems, especially for children with chronic diseases. Continuity-of-information (COI) errors occur when relevant information is not transmitted effectively. Follow-up errors occur when a recommended visit or telephone contact does not take place when prescribed. A study was undertaken to assess the COI and follow-up between a tertiary care pediatric emergency department (ED) and PCPs for pediatric patients seeking acute asthma treatment.


METHODS
Paper charts were reviewed for evidence of continuity of information and continuity of follow-up within the directed five-day period after an asthma exacerbation as recommended in national guidelines.


RESULTS
Three-hundred fifty pediatric ED visits for asthma by patients attending these community health centers were identified. In 132 (37.7%) of the records, there was no evidence of the patient's ED visit in the record (faxed ED discharge note or handwritten note by provider). In 219 (62.6%), the faxed ED note and/or provider note was present. Illegibility did not contribute to COI errors. There was no recorded contact between patients and PCPs in 218 (62.3%) of the charts, and 11 (3.1%) indicated appointments were scheduled but missed. Follow-up was documented in the remaining 121 (34.6%) charts--109 (31.1%) in clinic and 12 (3.4%) by phone follow-up.


CONCLUSIONS
More often than not, PCPs appeared to not know that their patients sought medical care in the ED for asthma exacerbations. The majority of patients did not follow up with their providers. More electronically automated and reliable ways of sharing information may diminish COI and follow-up errors and thereby improve patient safety.
Hsiao
Allen L
AL
Yale University School of Medicine, New Haven, CT, USA. allen.hsiao@yale.edu
Shiffman
Richard N
RN
D000293:Adolescent; D001249:Asthma / Q000628:therapy*; D002648:Child; D003237:Connecticut; D003266:Continuity of Patient Care; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D006786:Hospitals, Urban / Q000458:organization & administration; D006801:Humans; D019300:Medical Errors / Q000145:classification / Q000517:prevention & control*; D010372:Pediatrics / Q000592:standards; D011320:Primary Health Care / Q000458:organization & administration*