Closing 7 Communication Gaps Between the ER and Primary Care

Thursday, March 3rd, 2011
This post was written by Melanie Matthews

A new study has pinpointed seven barriers to effective communication between hospital ERs and primary care. Haphazard communication, poor coordination between ERs and primary care and insufficient time and reimbursement are the key culprits that can undermine effective care, according to the study conducted by the Center for Studying Health System Change (HSC).

HSC researchers conducted 42 telephone interviews between April and October 2010 with 21 pairs of emergency department and primary care physicians. The pairs were case-matched to hospitals so the perspectives of both specialties working with the same hospital could be represented.

The researchers identified seven areas where ER-PCP communication could be improved:

  • Real-time communication: Communicating via telephone was particularly time-consuming. Both ER and primary care physicians reported successful completion of each telephone call often required multiple pages and lengthy waits for callbacks.

  • Asynchronous communication: Asynchronous modes of communication such as faxes did not require breaks in task but had significant limitations as well. Faxed records can be reviewed at providers’ convenience but do not provide an opportunity to converse in real time and ask questions. Physicians had little confidence that faxes were carefully reviewed by their intended recipient and often reported that faxed records were poorly organized and difficult to decipher.

  • Shared electronic medical records (EMRs): Sharing information through a fully interoperable EMR can address some barriers. However, while EMRs are valuable tools for billing and liability documentation, they are not yet designed to offer a rapid overview of a patient’s case that is relevant to a particular problem with the level of detail that could help an emergency provider direct care.

  • Lack of time and reimbursement: Emergency and primary care physicians most commonly cited insufficient time and lack of reimbursement as significant barriers to communication. While care coordination activities might seem straightforward and quick, providers noted that each small action multiplied across dozens of patients can become a daunting burden, with little immediate reward.

  • Limited role of cross-covering providers: Respondents agreed that time invested in care coordination through a cross-covering PCP yielded much less value because cross-covering physicians rarely knew the patient and were less likely to offer data that would change an ER physician’s plan of care.

  • Changing interpersonal relationships: Rising hospitalist use and the growth of larger primary care groups inevitably decrease interactions between office-based and hospital-based physicians. Many ER physicians reported that they had no venues for ongoing collaboration with PCPs in their community.

  • Risk and malpractice liability concerns: Liability concerns may keep providers from participating fully in care coordination. Many respondents noted that ER and primary care physicians are bound by different constraints and have fundamentally different assumptions regarding patients’ reliability and resilience.

    The study was conducted for the nonpartisan, nonprofit National Institute for Health Care Reform (NIHCR).

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