Communication lapses between clinicians lead to poor care coordination, readmissions

Communication--or often the lack thereof--between hospital clinicians and primary care providers often results in poor care coordination after discharge and a greater chance of patient readmissions, according to a new study published in the Journal of General Internal Medicine.

Researchers, led by Christine D. Jones, M.D., assistant professor of medicine and director of the Hospital Medicine Group of the Care Transitions Program, conducted a qualitative study of 58 clinicians in four hospitalist focus groups, three primary care physician focus groups, and one hybrid group of both hospitalists and primary care providers in North Carolina. The team interviewed the clinicians about care coordination, information exchange, follow-up care, accountability and medication management.

They found that both hospitalists and primary care physicians experienced similar challenges, including lack of time, difficulty reaching other clinicians, lack of personal relationships with other clinicians, lack of information feedback, medication list discrepancies and a lack of clarity regarding accountability for pending tests and home health.

Hospitalists also noted trouble obtaining timely follow-up appointments for after-hours or weekend discharges.

Primary care physicians complained they often didn't know when patients were hospitalized, did not have access to hospital records for post-hospitalization appointments, had trouble finding important information in discharge summaries and often felt "undervalued" when hospitalists made changes to their patients' medications without involving them.

Both types of clinicians noted a greater need for care coordination for high-risk patients, improved direct telephone access to each other, improved information exchange through shared electronic medical records, enhanced interpersonal relationships and clearly defined accountability.

The study authors said that further research is necessary to see whether accountability for pending tests and home healthcare via formal service agreements between hospitalists and primary care physicians would actually lead to fewer missed test results and hospital readmissions.

In an accompanying opinion piece, Mitchell D. Feldman, M.D., of the Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, stressed the importance of communication. "A failure to communicate in the healthcare setting is not simply an inconvenience, it can result in delayed diagnoses, unnecessary tests, increased costs, and at times, may contribute to avoidable but disastrous clinical outcomes," he wrote.

To learn more:
- here's the study abstract
- read the study announcement
- here's the opinion piece (subscription required)