Background: Communication is critical to high-quality care transitions, yet little is known about the quality of information transfer from the hospital to home health care (HHC) setting. We performed a cross-sectional survey of HHC nurses and staff to evaluate their perspective on the completeness of medical information transferred from hospitals to HHC agencies in Colorado.
Methods: Based on themes identified from a prior qualitative analysis, we developed a survey for HHC nurses and staff. Survey questions were validated through semi-structured interviews with 5 HHC nurses. Between January and June 2017, we evaluated a web-based 48-question survey by contacting the 56 HHC agencies participating in the Home Care Association of Colorado, and reaching out to individuals from agencies that were willing to participate. The survey explored the completeness of patient-related information exchange at hospital discharge. Respondents selected answers on a Likert scale and enter free-text comments.
Results: Among 56 HHC agencies contacted by email, 14 (25%) were willing to participate. Within participating agencies, 50 of 122 individuals (41%) responded. Among respondents, 25 (50%) identified as frontline HHC nurses, 16 (32%) as HHC managers, 7 (14%) as administrators, and 2 (4%) as quality assurance clinicians. The majority (58%) were 50 years and older; 38% delivered HHC in rural areas, 30% in suburban, 24% in urban areas, and 8% in multiple settings. Most (62%) worked in for-profit HHC agencies. At the time of hospital discharge 42% of respondents had “occasional” or “rare” access to sufficient information about a patient’s hospitalization and 44% indicated they “often” to “almost always” encountered problems related to not having adequate information about a patient.
The most common elements of discharge communication identified as insufficient were: additional tests recommended by hospital clinicians (58%), pending studies for follow up (56%), which clinician to contact with questions (54%), patient-related safety issues (54%), and contact isolation status (50%). Altogether, 78% of respondents found it at least “somewhat difficult” to reach the appropriate physician with questions. Most respondents (90%) indicated that internet-based access to the hospitals electronic medical record would be useful. A representative free text statement describes one respondent’s experience with post-discharge communication: “It does no good to call the Hospitalist after discharge. Most of them have no concern for the patient after they leave the facility. (Sad)”
Conclusions: Information exchange between hospitals and HHC staff is suboptimal. We identified multiple opportunities to enhance the information provided during the transition from hospital to HHC. Respondents expressed the need for accurate hospitalist contact information, access to electronic health records, and engagement with HHC clinicians beyond hospital discharge.