Bridging the Gap: Hospitalist Communication with PCPs
Outpatient providers are playing an increasingly important role in preventing hospital readmissions. Historically, communication between hospitalists and primary care physicians have revolved around the discharge summary, but studies have shown that nearly half of hospitalized patients experience a medical error after discharge, and 19–23% suffer from an adverse event.
While hospitals are placing increased emphasis on helping patients understand discharge instructions and adhere to a post-discharge plan, there remains a disconnect between the inpatient providers and PCPs. From our experiences and learnings at Medisas, we have identified key issues and strategies to bridge the communication gap as patients transition across settings.
1. Timely communication with PCPs for discharge
A JAMA study showed that direct communication between hospital physicians and PCPs occurred for 3–20% of discharges, and only 12–34% of first post-discharge visits had a discharge summary available. Timely communication between hospitalists and PCPs is key: a large retroactive chart review study found a trend towards decreased readmission risk for patients whose PCPs had discharge summaries available at the time of their follow-up visit.
2. Standardize discharge information conveyed to PCPs
Patient safety is at risk when salient information about the inpatient stay fails to be conveyed to the PCP. In fact, only 25% of discharge summaries mention pending tests, leaving PCPs unaware of important follow-up needs.
The information provided to the PCP and channels for hospitalists to reach them should be standardized, leveraging tools such as discharge checklists or a system for notification of post-discharge test results. Checklists should ideally include the diagnosis, reconciled discharge medications, results of procedures, follow-up needs, and any pending test results. In leveraging electronic checklists, email, and fax, Billings Clinic increased patients follow-up visits with PCPs after discharge. These patients were also found to be less likely to be readmitted or require an emergent care visit.
3. Communicate with PCPs upon and throughout admission
1 in 4 PCPs are unaware that their patient has been admitted to a hospital. Of the ones who are aware, only 23% receive direct communication from an inpatient physician at any point during hospitalization. The disconnect can result in inaccurate medication reconciliation, unnecessary repetition of previous studies, and inadequate understanding of the medical history or home environment at time of admission.
As a first step, make sure that the inpatient providers know where and how to find the patient’s PCP information, including contact method. Develop a standard system in which PCPs are notified by phone, email, text, or other communication channels upon the patient’s admission and at key points throughout the patient stay.
