JAMA Study Shows Dangerous Gaps in Provider Communication at Discharge. HealthConnect at Cutting Edge of IT Approaches to Better Care Coordination
Significant gaps remain in the coordination of care at discharge, according to a comprehensive study recently published in JAMA, especially around issues of provider communication at discharge (Kripalani et al., JAMA , 2/28/07.
The study authors analyzed data from 55 observational studies to identify the timeliness, content, and format of discharge communications. They found that direct communication between hospital-based physicians and PCPs was infrequent, and discharge summaries were often delayed or incomplete; just 3% of PCPs reported involvement in discharge discussions and fewer than 20% reported "always being notified about discharges." Availability of discharge summaries to PCPs was likewise low, with the documents being provided in just 12% to 34% of cases for the first post-discharge visit and in 51% to 77% of cases at one month follow-up. Given that patients often visit their PCP within one month after hospitalization, the study calls for more stringent discharge communication guidelines and in 2006 JCAHO renewed its appeal for standardized handoff communications and timely completion of discharge summaries (JCAHO recommends completion of discharge summaries within 30 days).The standardization of discharge procedures is key and the authors also note that healthcare information technology plays a major role in ensuring care coordination, improving the delivery and quality of discharge communication.
All of which serves to underline KP's foresight and commitment to quality and safety when we chose to embark on our epic HealthConnect journey.
Studies like this and many others have shown that extracting patient data directly from the system and organizing it into a structured summary for review by caregivers will speed up the transmission of crucial information, enhancing accuracy, quality, and safety. While other hospitals and health systems are struggling to create communication systems between PCPs and the inpatient side, thanks to our investment in HealthConnect, we at Kaiser are a long ways ahead on the road to having clinical information available 24/7 to clinicians. In addition, any individual's entire record can be viewed by more than one clinician at any point in time. This makes it possible to easily update patient records and will make it easier for caregivers to review the most up-to-date information about the patient. Having the complete medical record available will ensure complete knowledge regarding co-morbidity, past visits and complaints, and recommendations the patient has received from other clinicians. In addition, test results are immediately available electronically. This means that clinicians at KP will always be able to work with the most complete information available and provide the best service possible.