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Context The viability and integrity of the health care system is possibly the most important preoccupation of the Canadian population as emphasized in the recent report of the Commission on the Future of Health Care in Canada 1 . The public perception of our health care delivery is that it is itself ailing as a result of deep budget cuts and inefficiency. Policy makers are eagerly seeking creative and innovative solutions that can reduce the frustration that both patients and health care providers experience when navigating the system. A possible solution to improve the satisfaction and quality of care is to address the continuity of care problem. Actual dysfunction of the health care system is often associated with emergency department (ED) overcrowding. Recent headlines appearing nation-wide have highlighted this crisis in ED care. Issues faced by EDs across the country and solutions to solve them are of keen interest to policy makers. A suggested means of improving continuity of care would be through enhanced linkages between the ED and the primary care network (PCN) which would result in a more appropriate, efficient and rational utilization of resources in both milieus. Thus, the aim of this project was to explore the deficiencies in communication between EDs and PCPs, develop a computer-based electronic network that would serve as a standardized communication system (SCS) linking the ED and PCPs and measure the impact of such a system. Unfortunately, very little communication exists between these two sources of care. Physicians from both the ED and the PCN must treat and manage patients with missing or incomplete information. Continuity of care between the ED and the PCN depends on improving communication between these two settings 2 . Knowledge of a patient’s visit to an ED is critical for PCPs since it allows them to know that their patient has experienced a major change in their health status. Perhaps more importantly however, it will enable informed and effective followup of an ED visit and empower the PCP to act as a real coordinator of care 3 . In order to achieve these fundamental objectives, the PCN must, at a minimum, have knowledge of the visit, the diagnosis, and the treatment plan. Such information is all too often unavailable to family physicians in a format that is both sufficiently detailed and accessible in a reasonable time frame to allow participation in a patient’s medical care. Family physicians have indicated that continuity of care is difficult in the PCN because of significant problems with communication between acute care facilities and the PCN 4 . Family physicians report problems with obtaining 1
key information (test results, consult notes and discharge information) in a manner that is sufficiently timely and complete to allow for continuity of patient care after hospitalization of ED care. The few EDs that do contact the PCN with information regarding patient visits usually do so via mail delivery of hand-written notes. Rubinstein et al. 5 evaluated both emergency and family physicians’ opinions of such mail-delivered summaries. These reports were actually carbon copies of the treating emergency department physician’s record and were supposed to contain data on diagnosis, disposition and pertinent lab tests. The perceived impact of this system according to the physicians using them (emergency physicians and family physicians) was decreased speciality referrals by both emergency and family physicians as well as decreased test ordering and increased visits to hospitalized patients by their family physicians. The family physicians surveyed in the study however reported significant deficiencies in that same system, including transmission delays, incomplete and scant content as well as illegibility. Reducing or eliminating these deficiencies may serve to enhance both the perceived and real benefits. To achieve high levels of continuity of care and quality of care treating physicians depend on greater access to information from other health care providers. Three aspects of this communication must be addressed: 1) the content of the information to be communicated, 2) the format of the information exchanged and 3) the modality for the communication. Van Walraven and Rokosh 6 surveyed hospital based physicians-in-training and community family physicians about the importance of various information elements as they might be included in hospital discharge summaries. The results indicate a strong consensus between hospital and family physicians. Elements rated as most important are admitting diagnosis, history of presenting illness, in-hospital therapeutic procedures, complications during hospital stay, consultations in hospital, discharge diagnoses, all discharge medication information, arranged medical follow-up, medical or social issues outstanding at patient discharge, and active medical problems at discharge. Wass 3 observed that following a patient’s visit to an emergency department, general practitioners wished to receive details of the results of investigations, diagnosis, treatment plan and follow-up arrangements. As for important format characteristics influencing the quality and 3, 7,8 use of discharge summaries, studies have concluded that the summary needs to be succinct and delivered quickly 7 . 2
Page 1 and 2: The Impact of a Standardized Inform
Page 3 and 4: The Impact of a Standardized Inform
Page 5 and 6: Executive Summary Context Inadequat
Page 7: 4. Do patients value the standardiz
Page 11 and 12: to an absence of an efficient commu
Page 13 and 14: Managers in the hospital-based and
Page 15 and 16: Call for tenders A document incorpo
Page 17 and 18: Implementation of the tool Sir Mort
Page 19 and 20: Questionnaire development Questionn
Page 21 and 22: Information transfer from ED to PCP
Page 23 and 24: account for this repeated measureme
Page 25 and 26: A post study focus group was held t
Page 27 and 28: In comparison with mailed copies of
Page 29 and 30: Visit to PCP and reason of visit 80
Page 31 and 32: methods that are seamless and bi-di

Full Report - Fondation canadienne pour l'amÃ©lioration des services ...

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