Hsiao Allen L, Shiffman Richard N
Yale University School of Medicine, New Haven, CT, USA.
Jt Comm J Qual Patient Saf. 2009 Sep;35(9):467-74. doi: 10.1016/s1553-7250(09)35065-5.
The handoff of patient care from emergent to primary care physicians (PCPs) has been associated with critical safety problems, especially for children with chronic diseases. Continuity-of-information (COI) errors occur when relevant information is not transmitted effectively. Follow-up errors occur when a recommended visit or telephone contact does not take place when prescribed. A study was undertaken to assess the COI and follow-up between a tertiary care pediatric emergency department (ED) and PCPs for pediatric patients seeking acute asthma treatment.
Paper charts were reviewed for evidence of continuity of information and continuity of follow-up within the directed five-day period after an asthma exacerbation as recommended in national guidelines.
Three-hundred fifty pediatric ED visits for asthma by patients attending these community health centers were identified. In 132 (37.7%) of the records, there was no evidence of the patient's ED visit in the record (faxed ED discharge note or handwritten note by provider). In 219 (62.6%), the faxed ED note and/or provider note was present. Illegibility did not contribute to COI errors. There was no recorded contact between patients and PCPs in 218 (62.3%) of the charts, and 11 (3.1%) indicated appointments were scheduled but missed. Follow-up was documented in the remaining 121 (34.6%) charts--109 (31.1%) in clinic and 12 (3.4%) by phone follow-up.
More often than not, PCPs appeared to not know that their patients sought medical care in the ED for asthma exacerbations. The majority of patients did not follow up with their providers. More electronically automated and reliable ways of sharing information may diminish COI and follow-up errors and thereby improve patient safety.
患者护理从急诊医生交接给初级保健医生（PCP）一直与严重的安全问题相关，尤其是对于患有慢性病的儿童。当相关信息未有效传递时，就会发生信息连续性（COI）错误。当规定的复诊或电话联系未进行时，就会发生随访错误。本研究旨在评估三级儿科急诊科（ED）与为寻求急性哮喘治疗的儿科患者的初级保健医生之间的信息连续性和随访情况。
按照国家指南的建议，对纸质病历进行审查，以寻找哮喘发作后指定的五天内信息连续性和随访连续性的证据。
确定了这些社区卫生中心的患者因哮喘到儿科急诊科就诊350次。在132份（37.7%）记录中，病历中没有患者急诊就诊的证据（传真的急诊出院记录或提供者的手写记录）。在219份（62.6%）记录中，有传真的急诊记录和/或提供者记录。字迹模糊并非信息连续性错误的原因。在218份（62.3%）病历中没有患者与初级保健医生之间已记录的联系，11份（3.1%）表明已安排预约但患者未就诊。在其余121份（34.6%）病历中有随访记录——109份（31.1%）是门诊随访，12份（3.4%）是电话随访。
初级保健医生似乎常常不知道他们的患者因哮喘发作而去急诊就诊。大多数患者没有与他们的医疗服务提供者进行随访。更多电子自动化且可靠的信息共享方式可能会减少信息连续性和随访错误，从而提高患者安全。
