TUESDAY, Feb. 27, 2007 (HealthDay News) -- There could be a potentially dangerous gap in communication between the doctor that treats you in the hospital and your primary care physician, new research suggests.
Direct communication between physicians who treated a patient in the hospital and the patient's regular doctor occurred in less than one in five cases at the time the patient was discharged from hospital care, the researchers found.
That communication breakdown could put patients at risk for serious medical errors, contends the study, which is published in the Feb. 28 issue of the Journal of the American Medical Association.
"There have been some studies showing that approximately 20 percent of patients experience some kind of adverse event after hospitalization, primarily in the first month, and that adverse event is often related to sub-optimal communication, either between the physician and the patient or between physicians," said the study's lead author, Dr. Sunil Kripalani, an assistant professor of medicine at Emory University School of Medicine in Atlanta.
The good news, said Kripalani, is that professional societies for both hospital physicians (sometimes called hospitalists) and primary care physicians are focusing on this issue and working on improving communication between doctors.
Those changes can't come soon enough for Dr. Rick Kellerman, president of the American Academy of Family Physicians. "I think we've been going backwards, and there's more discontinuity between the primary care and hospital communities," he said.
But, he added, "Physicians have got to understand that hospitalization is just a small, but important piece of a patient's life, and that continuity of care is provided by the family physician back home. We need all physicians on the same page."
To shed some light on this issue, Kripalani -- a hospitalist himself -- and his colleagues reviewed 73 studies that looked at the way information was transferred at the time of a hospital discharge or at how to improve that information transfer.
They found that direct communication between the hospitalist and the primary care doctor occurred between 3 percent and 20 percent of the time. That means that doctors from the hospital spoke to patients' regular doctors in one out of five cases or less.
This lack of direct communication means that many people end up being their primary care doctor's initial source of information about their hospitalization, the experts said. Between 16 percent and 53 percent of patients saw their primary care doctor before their physician had received a discharge letter. The problem is, patients often don't know what medications they're taking or at what dosage, or if they need follow-up lab work.
There were other important information gaps, the study found. Outpatient doctors estimated that care was compromised for nearly one in four patients because of a delay in receiving hospital discharge data or because a discharge summary was missing important information.
When discharge information was available, diagnostic test results were missing in 33 percent to 63 percent of cases, information on medications prescribed was missing in 2 percent to 40 percent, information on test results pending was missing in 65 percent of the cases, and follow-up plans for the patient weren't included between 2 percent and 43 percent of the time.
"This study is indicative of a larger problem in the health care system -- one of discontinuity and defragmentation," said Kellerman.
And, in this case, the problem isn't too hard to fix, he said.
"A simple phone call -- it doesn't have to be long -- just to let me know that the patient is going home and what was done in the hospital," suggested Kellerman. He also suggested that patients be given a form that details what procedures they had done, what labs were ordered, what lab tests still need to be done, and any medication changes that they can take to their primary doctor.
Kripalani suggested some of the same interventions and noted that electronic health records will likely improve communication between doctors as well.
Additionally, he recommended that consumers be engaged in their own health care. "If you're going to the hospital, bring contact information for your primary care physician along with a list of all the medications you're taking and their dosages, as well as a list of any medical diagnoses," Kripalani said. "At the time you leave the hospital, encourage the inpatient physician to contact your primary care physician by phone, fax or e-mail, and request a document that contains information on what you were treated for, the medications you're on, and what issues need to be followed up on after discharge," he added.
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