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Information transfer from ED to PCP
Modes of communication already in place between the ED and family physicians were
maintained over the study period. The standard method of communication at the JGH-ED is to
send a copy of the ED notes by mail to the family physicians associated with the JGH of patients
presenting to the ED. The copy is the first page of the patient’s ED notes that may include
information similar to the SCS. This method was used for the control group. As for the
intervention group, information transfer was through SCS as well as through the standard mode
which is the sending of a carbonated copy of the ED note by mail.
Information transfer from PCP to ED
For consented patients (intervention and control arms), medical information was collected from
the chart and emergency physicians. For the visits in the intervention arm, patient charts were
flagged (annex I) so that the treating ED physician could identify that patient is part of the study
(intervention arm). Emergency physicians could then ask the research assistants to contact the
FP and obtain the information requested. To facilitate the medical information transfer requested
by the ED, FPs offices and the ED were equipped with dedicated fax lines. As well, the FPs
secretaries were instructed to give priority to such requests. A fax form was specifically
developed (annex I) for the study. A RA would communicate the information faxed back from
the PCP office to the ED physician.
Evaluation of the impact of SCS tool
The first part of the analysis was to compare if the control and intervention arms were alike as
for socio demographic. Six variables were used for baseline comparison: age, gender, LOS,
admission, ambulance and stretcher. The primary outcomes included: resource utilization in and
out of ED (in FP office) and continuity of care. Secondary outcomes included: FP satisfaction
with SCS tool, FP practice satisfaction, FP perceived knowledge of patients, patient satisfaction
and patient’ representation of their FP. For each outcome, comparisons were done between the 2
groups (intervention and control). Due to the study design the analysis on resource utilization
and continuity of care were performed considering the cluster (FP cluster) and lag effect (crossover
adaptation curve to new group).
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