Attitudes and Satisfactions of Primary Care Physicians and Hospitalists in Communication Regarding Hospitalized Patient Care

Background:

Poor communication on hospital discharge between hospitalists and primary care physicians (PCPs) may result in worse patient outcomes, adverse medication events, decreased patient and physician satisfaction, and increased costs. Conversely, excellent communication may improve quality of care.

Purpose:

The purposes of the study were (1) to evaluate the desired method of communication and the content of the discharge summaries for timely and effective communication with primary care physicians and (2) to identify barriers in communication with PCPs regarding hospitalized patients.

Methods:

A 13‐question survey was sent to hospitalists and PCPs at HealthPartners Medical Group. As well, residents in the Internal Medicine Training Program at the University of Minnesota were surveyed about preferences of methods of communication, effectiveness of communication, and important elements of the discharge summary.

Results:

We received responses from 35 of 120 PCPs (29%), 22 of 55 hospitalists (40%) of HealthPartners Medical Group, and 65 of 119 internal medicine residents (55%). Of the PCPs, only 11% were “very satisfied” and 57% were “satisfied” with communication. PCPs preferred to communicate with hospitalists by e‐mail (85%), at admission (75%), and at discharge (90%). One hundred percent preferred to see the discharge summary before the patient is seen in follow‐up. “Very important” elements of the discharge summary included discharge diagnosis (91%), hospital course (85%), pending laboratory results (80%), and discharge medications (100%). Thirty‐six percent of PCPs believed that their patients suffered adverse outcomes because of poor communication between hospitalists and PCPs, mainly (>80%) due to duplications in medications. Less important elements of the summary included participating in making advance‐directive decisions (45%), change in clinical status (37%), making crucial management decisions (25%), and discharge disposition (24%). Of the hospitalists, only 62% were satisfied with communication with PCPs. They believed that their busy practice was the most important barrier (57%). Forty‐four percent believed they could not complete discharge summaries in a timely manner. Of the residents, more than 70% used the discharge summary in subsequent hospital admissions, and more than 80% believed that the busy schedule, postcall, days off, and unavailability of charts are the main barriers to timely completion of the discharge summary.

Conclusions:

Hospitalists and PCPs are dissatisfied with current communication with each other. It is important for hospitalists to establish PCPs' preferred method of communication. The discharge summary should be tailored to include those elements considered most important in order to avoid indiscriminate and voluminous communication and to improve the transition of care after hospital discharge.

Author Disclosure:

I. Ahmed, none; K. Frisch, none; P. Skarda, none; E. Gertner, none.