Coghlin Daniel T, Leyenaar Joanna K, Shen Mark, Bergert Lora, Engel Richard, Hershey Daniel, Mallory Leah, Rassbach Caroline, Woehrlen Tess, Cooperberg David
The Warren Alpert Medical School of Brown University, Hasbro Children's Hospital, Providence, Rhode Island;
Hosp Pediatr. 2014 Jan;4(1):9-15. doi: 10.1542/hpeds.2013-0022.
Professional medical societies endorse prompt, consistent discharge communication to primary care providers (PCPs) on discharge. However, evidence is limited about what clinical elements to communicate. Our main goal was to identify and compare the clinical elements considered by PCPs and pediatric hospitalists to be essential to communicate to PCPs within 2 days of pediatric hospital discharge. A secondary goal was to describe experiences of the PCPs and pediatric hospitalists regarding sending and receiving discharge information.
A survey of physician preferences and experiences regarding discharge communication was sent to 320 PCPs who refer patients to 16 hospitals, with an analogous survey sent to 147 hospitalists. Descriptive statistics were calculated, and χ² analyses were performed.
A total of 201 PCPs (63%) and 71 hospitalists (48%) responded to the survey. Seven clinical elements were reported as essential by >75% of both PCPs and hospitalists: dates of admission and discharge; discharge diagnoses; brief hospital course; discharge medications; immunizations given during hospitalization; pending laboratory or test results; and follow-up appointments. PCPs reported reliably receiving discharge communication significantly less often than hospitalists reported sending it (71.8% vs 85.1%; P < .01), and PCPs considered this communication to be complete significantly less often than hospitalists did (64.9% vs 79.1%; P < .01).
We identified 7 core clinical elements that PCPs and hospitalists consider essential in discharge communication. Consistently and promptly communicating at least these core elements after discharge may enhance PCP satisfaction and patient-level outcomes. Reported rates of transmission and receipt of this information were suboptimal and should be targeted for improvement.
专业医学协会支持在出院时及时、一致地向初级保健提供者（PCP）传达出院信息。然而，关于应传达哪些临床要素的证据有限。我们的主要目标是识别并比较PCP和儿科住院医师认为在儿科出院后2天内必须传达给PCP的临床要素。次要目标是描述PCP和儿科住院医师在发送和接收出院信息方面的经历。
我们向320名将患者转诊至16家医院的PCP发送了一份关于出院沟通的医生偏好和经历的调查问卷，并向147名住院医师发送了类似的调查问卷。计算描述性统计数据，并进行χ²分析。
共有201名PCP（63%）和71名住院医师（48%）回复了调查。超过75%的PCP和住院医师报告称7个临床要素至关重要：入院和出院日期；出院诊断；简要住院过程；出院用药；住院期间接种的疫苗；待处理的实验室或检查结果；以及随访预约。PCP报告称可靠接收出院沟通的频率显著低于住院医师报告发送出院沟通的频率（71.8%对85.1%；P<.01），并且PCP认为这种沟通完整的频率显著低于住院医师（64.9%对79.1%；P<.01）。
我们确定了PCP和住院医师认为在出院沟通中至关重要的7个核心临床要素。出院后持续、及时地至少传达这些核心要素可能会提高PCP的满意度和患者层面的治疗效果。报告的该信息传递和接收率不理想，应针对性地加以改善。
