"Why Is This Patient Being Sent Here?": Communication from Urgent Care to the Emergency Department.
BACKGROUND
Despite patients' increasing use of urgent care centers (UCC), little is known about how urgent care clinicians communicate with the emergency department (ED).


OBJECTIVE
To assess ED clinicians' perceptions of the quality and consistency of communication when patients are referred from UCCs to EDs.


METHODS
Emergency medicine department chairs distributed a brief, electronic survey to a statewide sample of ED clinicians via e-mail. The survey included multiple-choice and free-text questions focused on types of communication desired and received from UCCs, types of test results available on transfer, and suggestions for improvement.


RESULTS
Of 199 ED clinicians, 102 (51.3%) responded. More than four out of five respondents "somewhat" or "strongly agreed" that each of the following would be helpful: a telephone call, the reason for referral, specific concern, a copy of the chart, and UCC contact information. However, ED clinicians reported not consistently receiving these: only a fifth (21.6%) of clinicians reported receiving the specific concern for their last 5 patients transferred from a UCC, and 34.3% recalled receiving a copy of the chart. Overall, 54.9% reported receiving laboratory test results "often or almost always," 49.0% electrocardiograms, and 44.1% imaging reports. Qualitative analysis revealed several themes: incomplete data when patients are referred; barriers to discussion between ED and urgent care clinicians; and possible solutions to improve communication.


CONCLUSIONS
Our findings highlight variation in communication from UCCs to EDs, indicating a need to improve communication standards and practices. We identify several potential ways to improve this clinical information hand-off.
Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island; Healthcentric Advisors, Providence, Rhode Island.
Rebekah
R
Gardner
Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island; Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, Rhode Island.
Esther K
EK
Choo
Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island; Healthcentric Advisors, Providence, Rhode Island; Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, Rhode Island; Department of Medicine-Geriatrics, Case Western Reserve University, Cleveland, Ohio.
Stefan
S
Gravenstein
Healthcentric Advisors, Providence, Rhode Island; Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, Rhode Island.
Rosa R
RR
Baier
D000554:Ambulatory Care Facilities / Q000458:organization & administration*; D001291:Attitude of Health Personnel; D003142:Communication; D003266:Continuity of Patient Care / Q000458:organization & administration*; D003299:Cooperative Behavior; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D006801:Humans; D007400:Interprofessional Relations; D058996:Quality Improvement / Q000458:organization & administration; D014164:Transfer Agreement / Q000592:standards*
care transitions; communication; hand-offs; quality improvement; urgent care centers