title: We need to talk: Primary care provider communication at discharge in the era of a shared electronic medical record.
abstract: BACKGROUND
  Poor communication between hospitalists and outpatient physicians can contribute to adverse events after discharge. Electronic medical records (EMRs) shared by inpatient and outpatient clinicians offer primary care providers (PCPs) better access to information surrounding a patient's hospitalization. However, the PCP experience and subsequent expectations for discharge communication within a shared EMR are unknown.
  
  
  METHODS
  We surveyed PCPs 1 year after a shared EMR was implemented at our institution to assess PCP satisfaction with current discharge communication practices and identify areas for improvement.
  
  
  RESULTS
  Seventy-five of 124 (60%) clinicians completed the survey. Although most PCPs reported receiving automated discharge notifications (71%), only 39% felt that notifications plus discharge summaries were adequate for safe transitions of care. PCPs expressed that complex hospitalizations necessitated additional communication via e-mail or telephone; only 31% reported receiving such communication. The content most important in additional communication included medication changes, follow-up actions, and active medical issues.
  
  
  CONCLUSIONS
  Despite optimized access to information provided by a shared EMR, only 52% of PCPs were satisfied with current discharge communication. PCPs express a continued need for high-touch communication for safe transitions of care. Further standardization of discharge communication practices is necessary.
authors.affiliation: Department of Medicine, University of California, San Francisco, San Francisco, California.
authors.forename: Leslie
authors.initials: L
authors.lastname: Sheu
authors.forename: Kelly
authors.initials: K
authors.lastname: Fung
authors.forename: Michelle
authors.initials: M
authors.lastname: Mourad
authors.forename: Sumant
authors.initials: S
authors.lastname: Ranji
authors.forename: Ethel
authors.initials: E
authors.lastname: Wu
mesh_terms: D001291:Attitude of Health Personnel; D003142:Communication; D057286:Electronic Health Records / Q000458:organization & administration*; D020445:Hospitalists; D006801:Humans; D007400:Interprofessional Relations; D010351:Patient Discharge; D058007:Physicians, Primary Care