ContextDelayed or inaccurate communication between hospital-based and primary care physicians at hospital discharge may negatively affect continuity of care and contribute to adverse events.ObjectivesTo characterize the prevalence of deficits in communication and information transfer at hospital discharge and to identify interventions to improve this process.Data SourcesMEDLINE (through November 2006), Cochrane Database of Systematic Reviews, and hand search of article bibliographies.Study SelectionObservational studies investigating communication and information transfer at hospital discharge (n = 55) and controlled studies evaluating the efficacy of interventions to improve information transfer (n = 18).Data ExtractionData from observational studies were extracted on the availability, timeliness, content, and format of discharge communications, as well as primary care physician satisfaction. Results of interventions were summarized by their effect on timeliness, accuracy, completeness, and overall quality of the information transfer.Data SynthesisDirect communication between hospital physicians and primary care physicians occurred infrequently (3%-20%). The availability of a discharge summary at the first postdischarge visit was low (12%-34%) and remained poor at 4 weeks (51%-77%), affecting the quality of care in approximately 25% of follow-up visits and contributing to primary care physician dissatisfaction. Discharge summaries often lacked important information such as diagnostic test results (missing from 33%-63%), treatment or hospital course (7%-22%), discharge medications (2%-40%), test results pending at discharge (65%), patient or family counseling (90%-92%), and follow-up plans (2%-43%). Several interventions, including computer-generated discharge summaries and using patients as couriers, shortened the delivery time of discharge communications. Use of standardized formats to highlight the most pertinent information improved the perceived quality of documents.ConclusionsDeficits in communication and information transfer at hospital discharge are common and may adversely affect patient care. Interventions such as computer-generated summaries and standardized formats may facilitate more timely transfer of pertinent patient information to primary care physicians and make discharge summaries more consistently available during follow-up care.

https://jamanetwork.com/journals/jama/articlepdf/205790/jrv70001_831_841.pdf

Deficits in communication and information transfer between hospital-based and primary care physicians: implications for patient safety and continuity of care.

How the past teaches the future: ACMI distinguished lecture.

Information technology is believed to be useful for the communication of discharge information between hospitals and community-based health practitioners. At least 20 projects were conducted in Australia between 1993 and 1997 to explore this idea. The value of these projects was at least $618- 000. Despite this level of activity there is no good evidence, either from these projects or the international literature, to suggest that information technology can improve the quality of discharge communications.

/pdf/a-review-of-the-role-of-information-technology-in-discharge-115uijsntj.pdf

A review of the role of information technology in discharge communications in Australia.

As computer-based electronic patients’ records replaced paper-based charts, hospital medical records departments gave way to computer centers that stored data on magnetic disks. As computer storage became cheaper and database designs became more efficient, medical databases grew in size and variety. Federated databases could store large volumes of aggregated data in multiple partitions, or as functionally oriented databases that were logically interconnected. Directly accessible from clinical applications, they allowed users to simultaneously access and query data for patient care, clinical research, and financial reimbursement. Extended central databases collected and managed data from different databases. Known as data warehouses, they could service ever-increasing volumes of data collected from ever-changing medical technologies. Larger warehouses developed partitions and data marts for subsets of data to serve users with specific needs. The need to store and query large collections of data led to the development of online analytical processing (OLAP), distributed database systems, distributed database management systems, and translational data processing between multiple data warehouses. With more powerful computers in the 1990s, physicians began to enter data directly into the patient’s electronic health record using the keyboard, mouse, and clinical workstation. Dedicated computers became database servers to store and integrate multiple databases. In the 2000s electronic health records became more common; in the 2010s federal funding produced more widespread diffusion of electronic health records, and advances in informatics resulted in more efficient data management of expanding, multi-media, patient care databases.

Medical Databases and Patient Record Systems

Since 1968 we at the Duke University Medical Center have been involved in the development and implementation of a computer system for use in patient care applications. During that 18-year period, our progress has been influenced by hardware, software, and people. This chapter presents the historical development of a clinical information system, now referred to as The Medical Record (TMR*), and discusses those factors that influenced philosophy, design, and implementation. The Medical Record grew out of a single-user, tape-oriented minicomputer package and now exists as a multi-user, multi-database, networked multicomputer system capable of supporting a wide variety of users in both inpatient and/or outpatient settings. This chapter describes the interaction and evolution of hardware technologies, system software technologies, and applications software capabilities. It discusses how those parameters meshed with the increasing sophistication of users and an expanding level of need and utilization along with the growing experience of the system designers. We include approaches that worked along with those that did not. The current system is described, and future directions are identified.

The Evolution of GEMISCH and TMR

Expansion of a computerized obstetric medical record to include newborn nursery information is described. Data sheets are entered for each infant discharged, and a computer-typed discharge summary is generated which abstracts information originally gathered by both obstetric and pediatric medical personnel. The system has improved communication with medical providers who administer follow-up care after discharge and has replaced some physician dictation effort, especially in the Full Term Nursery. In the Intensive Care Nursery the summary has not been successful because data collected is not felt adequate to describe the chronology of a long hospitalization. Comparison of the computer record and manual discharge diagnosis sheet is presented.

Computerized nursery discharge summary.

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Computerized nursery discharge summary.