Standardizing Communication From Acute Care Providers to Primary Care Providers on Critically Ill Adults

Abstract

Objective To increase the frequency of communication of patient information between acute and primary care providers. A secondary objective was to determine whether higher rates of communication were associated with lower rates of hospital readmission 30 days after discharge. Methods A validated instrument was used for telephone surveys before and after an intervention designed to increase the frequency of communication among acute care and primary care providers. The communication intervention was implemented in 3 adult intensive care units from 2 campuses of an academic medical center. Results The frequency of communication among acute care and primary care providers, the perceived usefulness of the intervention, and its association with 30-day readmission rates were assessed for 202 adult intensive care episodes before and 100 episodes after a communication intervention. The frequency of documented communication increased significantly (5/202 or 2% before to 72/100 or 72% after the intervention; P < .001) and the communication was considered useful by every participating primary care provider. Rates of rehospitalization at 30 days were lower for the intervention group than the preintervention group, but the difference was not statistically significant (41/202 or 23% vs 16/88 or 18% of discharged patients; P = .45; power 0.112 at P = .05). Conclusions The frequency of communication episodes that provide value can be increased through standardized processes. The key aspects of this effective intervention were setting the expectation that communication should occur, documenting when communication has occurred, and reviewing that documentation during multiprofessional rounds.

Hospital Discharge Summaries Are Insufficient Following ICU Stays: A Qualitative Study

“…Overall, our study indicates that discharge summaries fail to support effective transitions in many instances. Although little research has explored direct discharge-related communication between ICU teams and PCPs, our evidence aligns with others that suggest that PCPs value this communication (6, 26–28) and for a possible role for ICU discharge summaries, or an ICU-specific section within hospital discharge summaries, for outpatient follow-up specifically (20, 29). Puthucheary et al (30) piloted the use of a tool, completed by the ICU discharging physician, about patients’ rehabilitation needs.…”

Information sharing between intensive care and primary care after an episode of critical illness; A mixed methods analysis

“…The strongest predictors of GP dissatisfaction were the lack of either an ICU discharge letter or a notification about an unplanned ICU admission. In a further study, notifying GPs within 24hours of their patient’s admission to ICU helped GPs prepare for the discharge process back to the community [17]. Two recent qualitative studies explored patients’ and relatives’ perspectives about hospital discharge after an ICU admission.…”

“…Several small studies evaluate the transfer of patient information to GPs following an unplanned admission to an ICU. They demonstrate a paucity of clinical information, either directly from ICU staff or indirectly from other hospital medical teams [17–19]. Consequently, there is a discrepancy between the clinical information GPs expect and the information they receive about an ICU stay [20].…”