Poor communication found between primary care and emergency doctors
■ A study says the gap can cause redundant treatments and unnecessary ED visits.
By Tanya Albert Henry — Posted March 29, 2011
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Improving communication between primary care and emergency physicians won't be easy, but it could be fostered through changes in electronic medical records, payment incentives and liability reform, a study suggests.
After talking to 21 doctors in each specialty, researchers found spotty communication and poor coordination between the two groups.
When physicians in the two specialties don't talk, patients can receive duplicative or misapplied treatments and may be admitted for unnecessary emergency care, according to a February study that the Center for Studying Health System Change conducted for the National Institute of Health Care Reform, a nonpartisan health policy research group (link).
Poor communication also means that primary care physicians don't get the chance to talk to patients about when it is appropriate to use an emergency department, and they don't have a chance to learn if their lack of office availability may drive patients to an ED, study authors said.
Researchers found numerous communication barriers. For example, talking by telephone was time-consuming and required doctors to participate at the same time, which could interrupt work flows in the ED or office. Meanwhile, doctors said faxes, emails and text messages don't offer much back-and-forth, and it can be hard to know if a physician received the message.
"I don't want to send an email out to never-never land," one physician told researchers.
Doctors noted the limitations of electronic medical records, which aren't organized in a way that lets them quickly access specific information about a patient. Also, physicians say the fact that more hospitalists and fewer primary care physicians admit patients to hospitals has contributed to the problem. "We just don't communicate anymore, because we don't see each other anymore," one emergency physician said.
Emily Carrier, MD, senior researcher at the Center for Studying Health System Change, said there are no easy answers when it comes to improving communication. She said policymakers will need to examine a broad range of ways to address the problem, including:
- Shared electronic medical records. Creating a truly interoperable system that, for example, allows emergency physicians to read a patient's medical record and quickly search it for items related to what brought them to the ED. Also, the system would need to alert primary care physicians about a patient's ED visit.
- Payment reform. Setting up a system that rewards primary care physicians and hospitals for controlling costs and utilization could encourage better coordinated care. For example, if hospitals want to limit inpatient readmissions, they may be more likely to follow up with primary care doctors after a patient is discharged.
- Liability reform. Offering safe harbors from liability claims for doctors who coordinate care could lead to emergency physicians being more comfortable with not admitting an ED patient when a primary care physician tells the emergency physician that the admission is not necessary.
"I am hoping the message people take away is that if they are trying to promote communication, it is important to understand the work flow," Dr. Carrier said. "Communication needs to be done without disrupting the work flow. Look at how that can be done effectively."