Background: Insufficient communication, particularly at transitions in patient care, is a common and accepted cause of negative outcomes. Handoffs between hospitalists and primary care physicians (PCPs) are infrequent, occurring in 3-20% of cases (2).
Many institutions are using discharge summaries as automated methods of handing off the patient to the PCP, however it has been shown that these summaries are available by the first post-discharge follow-up visit only 12-34% of the time (2). This is a missed opportunity to ensure care continuity. In fact, poor communication adversely impacts patient care in 24% of cases (2). Moreover, notifying PCPs about admissions and discharges leads to a significant decrease in readmission rates (1).
In order to improve continuity of patient care after discharge from University of New Mexico Hospital (UNMH), we created a quality improvement project aimed to increase the accuracy of primary care provider (PCP) documentation in the electronic medical record (EMR).
Methods: Data was collected between 10/2016 and 2/2017 from hospitalized patients on 5 West, a general medicine inpatient unit, at UNMH. Patients were surveyed and asked if they had a PCP, and this data was compared to the EMR for accuracy.
Surveys were collected in REDCap and administered by the research group students. Participation was voluntary, and included 12 to 18 English and/or Spanish speaking patients each week, totaling 206 patients surveyed.
The team collecting and interpreting data included a hospitalist, an internal medicine resident and four medical students. Two PDSA cycles were completed.
Following baseline data collection, meetings were held with stakeholders to identify the most appropriate process for PCP documentation. It was agreed that PCP documentation will occur most efficiently at emergency department triage. The IT Team and emergency department triage team are currently working on implementing our suggested PCP input field during the triage process.
Results: 72% of patients report having a PCP at admission. 26% of patients have a PCP documented in the EMR. For those with a documented PCP practicing within the UNM system, it is correct 24% of the time. 0% of patients have a non-UNM PCP correctly documented.
Conclusions: PCPs are infrequently and inaccurately reflected by the EMR at UNMH, contributing to poor transition of care at the time of discharge. We have effectively located the problem and are moving forward with a plan to alter the EMR and the check-in protocol to allow emergency department technicians to input PCPs at the time of initial check-in and triage.