The "Hand-in" Project: Jump-starting Communication Between Inpatient and Outpatient Providers.

Area of Science:

• Health Services Research
• Medical Informatics
• Patient Care

Background:

• Communication between hospitalists and primary care providers (PCPs) is crucial for patient care transitions.
• While discharge communication is well-studied, the inpatient admission phase has received less attention.
• Standardized communication methods are needed to improve information exchange during outpatient-to-inpatient transitions.

Purpose of the Study:

• To evaluate the impact of a brief, standardized e-mail from hospitalists to PCPs upon patient admission.
• To determine if this intervention facilitates information exchange, increases communication, clarifies PCP preferences, and improves patient outcomes.
• To assess the feasibility and effectiveness of using encrypted e-mail for inter-provider communication.

Main Methods:

• A prospective, single-center study with a preintervention-to-postintervention design.
• 300 inpatient admissions were analyzed at the Veterans Affairs Connecticut Healthcare System.
• Hospitalists sent encrypted e-mails with standardized questions to PCPs within 24 hours of admission, measuring communication frequency, length of stay, readmissions, and ED visits.

Main Results:

• Postintervention, communications per patient significantly increased from 0.11 to 0.5 (P < 0.001).
• Length of stay, 30-day readmissions, and 30-day ED visits showed nonsignificant decreases.
• Primary care providers (PCPs) preferred e-mail for communication (40%) and desired follow-up within two weeks.

Conclusions:

• A hospitalist-led transition-of-care intervention using encrypted e-mail effectively enhanced communication and information exchange.
• The intervention provided valuable medical and psychosocial information and clarified PCP preferences.
• Despite increased communication, statistically significant improvements in length of stay, readmission rates, or ED visits were not observed.