Hunchak Cheryl, Tannenbaum David, Roberts Michael, Shah Thrushar, Tisma Predrag, Ovens Howard, Borgundvaag Bjug
*Schwartz-Reisman Emergency Centre,Mount Sinai Hospital,Toronto,ON.
†The Granovsky Gluskin Family Medicine Centre,Mount Sinai Hospital,Toronto,ON.
CJEM. 2015 Mar;17(2):123-30. doi: 10.2310/8000.2014.141327.
Postdischarge emergency department (ED) communication with family physicians is often suboptimal and negatively impacts patient care. We designed and piloted an online notification system that electronically alerts family physicians of patient ED visits and provides access to visitspecific laboratory and diagnostic information.
Nine (of 10 invited) high-referring family physicians participated in this single ED pilot. A prepilot chart audit (30 patients from each family physician) determined the baseline rate of paper-based record transmission. A webbased communication portal was designed and piloted by the nine family physicians over 1 year. Participants provided usability feedback via focus groups and written surveys.
Review of 270 patient charts in the prepilot phase revealed a 13% baseline rate of handwritten chart and a 44% rate of any information transfer between the ED and family physician offices following discharge. During the pilot, participant family physicians accrued 880 patient visits. Seven and two family physicians accessed online records for 74% and 12% of visits, respectively, an overall 60.7% of visits, corresponding to an overall absolute increase in receipt of patient ED visit information of 17%. The postpilot survey found that 100% of family physicians reported that they were ''often'' or ''always'' aware of patient ED visits, used the portal ''always'' or ''regularly'' to access patients' health records online, and felt that the web portal contributed to improved actual and perceived continuity of patient care.
Introduction of a web-based ED visit communication tool improved ED-family physician communication. The impact of this system on improved continuity of care, timeliness of follow-up, and reduced duplication of investigations and referrals requires additional study.
急诊室（ED）出院后与家庭医生的沟通往往不尽人意，对患者护理产生负面影响。我们设计并试点了一个在线通知系统，该系统以电子方式提醒家庭医生患者的急诊就诊情况，并提供特定就诊的实验室和诊断信息。
（受邀的10位中）9位高转诊家庭医生参与了此次单一急诊室试点。预试点病历审核（每位家庭医生30例患者）确定了纸质记录传输的基线率。一个基于网络的沟通门户由9位家庭医生在1年时间内进行设计和试点。参与者通过焦点小组和书面调查提供可用性反馈。
预试点阶段对270份患者病历的审查显示，手写病历的基线率为13%，出院后急诊室与家庭医生办公室之间任何信息传递的比率为44%。在试点期间，参与的家庭医生累计有880例患者就诊。分别有7位和2位家庭医生访问了74%和12%的就诊在线记录，总体访问率为60.7%，这相当于患者急诊就诊信息接收的总体绝对增加了17%。试点后调查发现，100%的家庭医生报告称他们“经常”或“总是”知晓患者的急诊就诊情况，“总是”或“经常”使用该门户在线访问患者的健康记录，并认为该网络门户有助于改善患者护理的实际和感知连续性。
引入基于网络的急诊就诊沟通工具改善了急诊室与家庭医生之间的沟通。该系统对改善护理连续性、随访及时性以及减少检查和转诊的重复所产生的影响需要进一步研究。
