F. Harl1, M. Saucke1, C. Greenberg1, A. Ingraham1 1University Of Wisconsin,Madison, WI, USA
Introduction: Poor communication can lead to fragmentation of care and adverse patient outcomes. Studies of transitions of care within a single hospital and at discharge suggest significant communication deficits. Communication during transfers across hospitals, which are inherently complex and at high risk for communication failures, has not been well-studied in surgical populations. This study assessed the written communication provided during interhospital transfers of emergency general surgery (EGS) patients. We hypothesize that EGS patients are often transferred with incomplete documentation of the workup, diagnosis, and treatment provided at referring facilities leading to uncertainty at the accepting hospital and wasted resources.
Methods: We performed a retrospective review of written communication during interhospital transfers of EGS patients. Patients transferred to our institution from outside emergency departments (ED) for emergency general surgical evaluation between 4/1/14 – 3/1/16 for 6 EGS diagnoses (appendicitis, cholecystitis, diverticulitis, bowel obstruction, perforated viscus, mesenteric ischemia) as assigned by accepting providers were included. Searching the existing comprehensive electronic medical record, which incorporates documents from referring hospitals, elements of written communication were abstracted in a standardized fashion and included the presence of outside records, documentation of the medical course and care, and information received after the patient’s arrival. Comprehensive descriptive statistics summarized the information communicated.
Results: Over the two year period, 129 patients met inclusion criteria. 87.6% (n=113) of charts contained referring hospital documents. Substantial numbers of history and physicals (42.5% [n=48]), diagnoses (9.7% [n=11]), and reasons for transfer (18.6% [n=21]) were missing. 91 CT scans were performed; of which, final reads were absent for 76.9% (n=70). 45 ultrasounds and x-rays were performed; of which, final reads were missing for 80% (n=36). Services outside the ED were consulted at the referring hospital for 32.7% (n=37) of patients; consultants’ notes were absent in 89.1% (n=33). In 12.4% (n=14), referring facility paperwork arrived after the patient’s ED arrival time, and thus was not part of the original written communication provided.
Conclusion: Effective communication is an essential component of patient care. This study documents that information critical to continuity of care is often missing in the written communication provided during interhospital transfers. Establishing the current state of this communication affords a foundation for the standardization of provider communication during interhospital transfers of EGS patients.