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Dropping the baton during the handoff from emergency department to primary care: pediatric asthma continuity errors

Allen L Hsiao1, Richard N Shiffman

  • 1Yale University School of Medicine, New Haven, CT, USA. allen.hsiao@yale.edu

Joint Commission Journal on Quality and Patient Safety
|September 23, 2009
PubMed

Insights

Primary care physicians often lack awareness of pediatric asthma patients visiting the emergency department (ED). Most children do not follow up with their doctors, highlighting a need for improved information sharing to enhance patient safety.

Area of Science:

  • Pediatric Emergency Medicine
  • Health Informatics
  • Patient Safety

Background:

  • Handoffs between emergency and primary care physicians pose safety risks, particularly for children with chronic conditions.
  • Continuity-of-information (COI) and follow-up errors are significant issues in pediatric care transitions.
  • This study investigated COI and follow-up for pediatric asthma patients seen in a tertiary care pediatric emergency department (ED).

Purpose of the Study:

  • To assess the continuity of information (COI) between a pediatric ED and primary care physicians (PCPs).
  • To evaluate the continuity of follow-up care for pediatric asthma patients after an ED visit.
  • To identify potential areas for improving patient safety in pediatric asthma management.

Main Methods:

  • A retrospective review of paper charts was conducted for pediatric patients treated for asthma in the ED.
  • The study assessed evidence of information continuity and follow-up within five days of the ED visit, per national guidelines.
  • Data were collected on the presence of ED visit documentation in PCP records and documented follow-up actions.

Main Results:

  • Of 350 pediatric asthma ED visits, 37.7% of PCP records lacked evidence of the ED visit.
  • While 62.6% of records contained ED notes, 62.3% showed no recorded contact between patients and PCPs.
  • Documented follow-up occurred in 34.6% of cases (31.1% clinic, 3.4% phone).

Conclusions:

  • PCPs were frequently unaware of their patients' ED visits for asthma exacerbations.
  • A majority of pediatric patients did not adhere to recommended follow-up care with their PCPs.
  • Implementing automated systems for information exchange could reduce COI and follow-up errors, improving pediatric patient safety.
Abstract

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