Content area
Full Text
No quick fixes, but process improvements and alternative communication modes can help
If improved care coordination is integral to bending the health care cost curve, then the interchange between emergency physicians and primary care practitioners (PCPs) is in need of significant improvement, according to a new study on this issue conducted by the Washington, DC-based Center for Studying Health System Change (HSC) for the nonprofit National Institute for Health Care Reform (NIHCR).
The report, Coordination Between Emergency and Primary Care Physicians , is based on telephone interviews with 41 pairs of emergency physicians and PCPs who were matched so that researchers could obtain the perspectives of both specialties working in the same hospital settings. (See "Editor's Note" below for link to report.) The study concludes that poor communication and poor coordination undermine effective patient care, and that there are no quick fixes to these problems. However, the authors stress that there are things ED managers can do to address existing barriers while at the same time reducing inefficiency, waste, and errors.
Unique challenges surface in the ED
Emily Carrier, MD, MSCI, a co-author of the study and a senior researcher at HSC, decided to look into the issue because, as an emergency physician herself, she has experienced firsthand the challenges of trying to coordinate with PCPs, but she has seen little research on the subject. "I saw that there had been a lot of thinking about how care can be better coordinated, but it hasn't really focused on this particular interface, so I wanted to fill in this gap," she explains.
Patient encounters in the ED are distinctly different from other care encounters in a number of ways that add complexity to the care coordination piece, says Carrier. "If you think about the classic PCP-specialist interaction, the PCP might identify the need for a specialist consultation, he might help the patient to schedule it, and prepare some information to be sent to the specialist's office in advance of the visit," says Carrier. "Then, after the evaluation, the specialist might send the information back to the PCP and the next time he looks at the file, he will read it over."
Typically, everybody knows what is going to happen next in such a situation, but...