Emergency Care: Primary care doctors often don"t know that a child sought care for asthma in the emergency department

Emergency Care
Primary care doctors often don’t know that a child sought care for asthma in the emergency department

When a patient with asthma seeks care for symptoms at an emergency department (ED), the ED staff should take steps to alert the patient’s primary care physician (PCP) so the PCP is aware of changes to medications and can avoid medical errors. However, a recent study finds that PCPs are not always informed that their patients visited EDs. Richard N. Shiffman, M.D., M.C.I.S., and his colleague at Yale University School of Medicine reviewed medical records of 350 children who regularly received care at community health centers (CHCs), but ended up in an ED after experiencing an asthma flareup.

Nearly 63 percent of patient records at the CHC contained faxed discharge summaries or a note from the ED provider, but the remaining 37 percent of records had no mention of the child’s ED visit. Faxes were the most common way (48 percent) EDs notified PCPs that a visit occurred. However, of the 168 faxes EDs sent, 98 percent did not state how long the asthma medications were to be used, 36 percent were missing dosing information, 34 percent did not include how often the drug was to be taken, and 11 percent lacked medication instructions or names. The authors suggest that e-mail and computerized notifications may be more reliable than faxes and phone calls for alerting PCPs of a patient’s ED visit. Further, nearly two-thirds of patients did not follow up with their PCP after an ED visit for asthma.

Automating notifications would remove the burden that falls on patients to arrange followup care and would transfer responsibility for initiating an office visit to the PCP, the authors suggest. This study was funded in part by the Agency for Healthcare Research and Quality (HS15420).

See “Dropping the baton during the handoff from emergency department to primary care: Pediatric asthma continuity errors,” by Allen L. Hsiao, M.D., and Dr. Shiffman in the September 2009 The Joint Commission Journal on Quality and Patient Safety 35(9), pp. 467-474.