Transfer of care of postsurgical patients from hospital to the community setting: cross-sectional survey of primary care physicians

Uppal, Navjeet; Eisen, David; Weissberger, Jeff; Wyman, Roy; Urbach, David R.; Bell, Chaim M.

doi:10.1016/j.amjsurg.2015.03.006

Cited by 9 publications

(8 citation statements)

References 16 publications

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“…28 33 PCPs caring for patients postinjury complain about poor communication from hospital clinicians about their patients 32 and over half of family physicians caring for postsurgical patients report that uncertainty regarding management has resulted in adverse events. 34 In addition, medical errors related to discontinuity of care from inpatient to outpatient settings are associated with increased rehospitalization. 35 Therefore, it is important that PCPs of hospitalized TACS patients be provided with timely, accurate discharge summaries.…”

Section: Discussionmentioning

confidence: 99%

“…Patients we interviewed experienced difficulties due to poor communication between the hospital clinician and a patient’s outpatient doctor, which is not unusual 28 33. PCPs caring for patients postinjury complain about poor communication from hospital clinicians about their patients32 and over half of family physicians caring for postsurgical patients report that uncertainty regarding management has resulted in adverse events 34. In addition, medical errors related to discontinuity of care from inpatient to outpatient settings are associated with increased rehospitalization 35.…”

Section: Discussionmentioning

confidence: 99%

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Patient and clinician perceptions of the trauma and acute care surgery hospitalization discharge transition of care: a qualitative study

McFadden

Gosdin

Jurkovich

et al. 2022

Trauma Surg Acute Care Open

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ObjectivesTrauma and acute care surgery (TACS) patients face complex barriers associated with hospitalization discharge that hinder successful recovery. We sought to better understand the challenges in the discharge transition of care, which might suggest interventions that would optimize it.MethodsWe conducted a qualitative study of patient and clinician perceptions about the hospital discharge process at an urban level 1 trauma center. We performed semi-structured interviews that we recorded, transcribed, coded both deductively and inductively, and analyzed thematically. We enrolled patients and clinicians until we achieved data saturation.ResultsWe interviewed 10 patients and 10 clinicians. Most patients (70%) were male, and the mean age was 57±16 years. Clinicians included attending surgeons, residents, nurse practitioners, nurses, and case managers. Three themes emerged. (1) Communication (patient-clinician and clinician-clinician): clinicians understood that the discharge process malfunctions when communication with patients is not clear. Many patients discussed confusion about their discharge plan. Clinicians lamented that poorly written discharge summaries are an inadequate means of communication between inpatient and outpatient clinicians. (2) Discharge teaching and written instructions: patients appreciated discharge teaching but found written discharge instructions to be overwhelming and unhelpful. Clinicians preferred spending more time teaching patients and understood that written instructions contain too much jargon. (3) Outpatient care coordination: patients and clinicians identified difficulties with coordinating ongoing outpatient care. Both identified the patient’s primary care physician and insurance coverage as important determinants of the outpatient experience.ConclusionTACS patients face numerous challenges at hospitalization discharge. Clinicians struggle to effectively help their patients with this stressful transition. Future interventions should focus on improving communication with patients, active communication with a patient’s primary care physician, repurposing, and standardizing the discharge summary to serve primarily as a means of care coordination, and assisting the patient with navigating the transition.Level of evidenceIII—descriptive, exploratory study.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Patient and clinician perceptions of the trauma and acute care surgery hospitalization discharge transition of care: a qualitative study

McFadden

Gosdin

Jurkovich

et al. 2022

Trauma Surg Acute Care Open

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“…This is among the initial work to provide clarity on key aspects essential to an orthopaedic-specific discharge summary. Other studies on discharge summaries have focused on medical inpatients with different challenges and needs [ 16 , 19 , 20 ]. In contrast to other studies, our sample included patients, reflecting comprehensive and diverse viewpoints.…”

Section: Discussionmentioning

confidence: 99%

Design of an orthopaedic-specific discharge summary

Soong

Kurabi

Exconde

et al. 2016

BMC Health Serv Res

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BackgroundPatients undergoing orthopaedic procedures experience major changes in function and daily routines upon their return home. Discharge summaries are an important communication tool that may play a role in optimizing a safe transition from hospital. Current care gaps and key elements of an ideal discharge summary specific for orthopaedic population are unknown. We sought to identify the challenges of current orthopaedic discharge summaries and to determine key elements of an ideal document.MethodsQualitative study survey using semi-structured interviews with a sample of 17 patients and clinicians representing diverse professions, backgrounds, and practice settings. We used the constant comparative method of qualitative analysis to define the experiences and perceptions of quality gaps and strategies to improve orthopaedic-specific discharge summaries.ResultsWe identified 3 major themes describing factors perceived to be limiting the quality of current discharge summaries: 1) physician-centric documentation and the absence of a comprehensive, inter-professional perspective; 2) access to resources and health informatics; and 3) process variations in document creation and dissemination.ConclusionsClinicians and patients identified several factors limiting the quality of discharge summaries among orthopaedic inpatients. Incorporating these elements could improve hospital transitions.

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“…A recent study found that only 12 per cent of primary care physicians in Canada were notified of their patients’ hospital encounters, and fewer than three in ten primary care physicians had electronic access to clinical data for patients under the care of multiple health organizations (Protti, 2015). An impressive 62 per cent of family physicians believe that inefficiency in care transfer from hospitals to primary care resulted in “uncertainty regarding management” of patient care that was directly associated with at least one adverse event (Uppal et al , 2015).…”

Section: A System View Of Safety and Riskmentioning

confidence: 99%

Leveraging supply chain infrastructure to advance patient safety in community health-care settings

Snowdon

Tallarigo

2018

LHS

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Purpose The purpose of this paper is to examine the opportunity for supply chain processes and infrastructure to reduce the risk of medical error and create traceability of adverse events in community care settings. Patient safety has become an important area of focus over the past few decades, with medical error now accounting for the third most common cause of death in Canada and the USA. The majority of patient safety studies to date have focused specifically on safety in hospital settings; however, deaths and harm experienced by patients in the community (home care, long-term care, complex care and rehabilitation settings) are not well understood. Design/methodology/approach This paper discusses the evidence that adverse events occur at similar, if not more, frequent rates in community care settings. Findings The authors propose that above and beyond current efforts to increase awareness and promote a "safety culture" in health-care settings, system infrastructure should be designed in a way that enables clinicians to provide the safest care possible. There is currently no line of sight across the health-care continuum. The authors suggest that improving system infrastructure would reduce the occurrence of adverse events. Originality/value Such visibility across the continuum of care holds the potential to transform health-care in Canada from a fragmented system, where information is inadequately captured and transferred from provider to provider, to a system that provides complete, accurate and up-to-date information regarding patient care, procedures, medications and outcomes so as to provide the best and safest care possible. System visibility achieves quality and safe care, which is transparent and accountable and achieves value for patients.

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Transfer of care of postsurgical patients from hospital to the community setting: cross-sectional survey of primary care physicians

Cited by 9 publications

References 16 publications

Patient and clinician perceptions of the trauma and acute care surgery hospitalization discharge transition of care: a qualitative study

Patient and clinician perceptions of the trauma and acute care surgery hospitalization discharge transition of care: a qualitative study

Design of an orthopaedic-specific discharge summary

Leveraging supply chain infrastructure to advance patient safety in community health-care settings

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