Survey finds low rates of communication between inpatient, primary care teams

Primary care physicians differed in their preferred mode of communication about patients' hospitalizations, with some preferring telephone contact, others preferring electronic health record notifications, and some wanting faxes.

Fewer than half of surveyed primary care clinicians reported receiving consistent notification of patients' hospitalizations despite a strong preference for communication with the inpatient team, according to a recent research letter.

From October 2015 to June 2016, researchers sent surveys to primary care clinicians from three practice groups either affiliated with or located near The Johns Hopkins Hospital in Baltimore: all general internal medicine faculty with outpatient practices (“academic,” two practice sites, n=35), all affiliated community-based primary care clinicians (“community,” 36 practice sites, n=220), and all primary care clinicians from an unaffiliated managed care organization (“unaffiliated,” five practice sites, n=29).

The 15-question survey, developed in collaboration between researchers and practice representatives, evaluated the primary care clinicians' interactions with inpatient teams, as well as their communication preferences. Results were published online on Nov. 8 by the Journal of Hospital Medicine.

Overall, 73 of 284 primary care clinicians completed the survey (14 academic [40%], 43 community [20%],and 16 unaffiliated [55%]), for a response rate of 26%. Overall, 31 clinicians (42%) reported receiving notification of admission upon every or almost every hospitalization, with no significant variation across practice groups.

About 88% (n=64) of the clinicians said they preferred communication at one or more points during hospitalizations, with most preferring communication both upon admission and prior to discharge (n=48; 66%). There were no significant differences between practice groups.

However, of the 64 clinicians who favored communication, preferred mode of contact varied significantly between groups, with the academic group having a greater preference for telephone (54%) than the community and unaffiliated groups (both 8%; P<0.001). The community group showed a greater preference for contact through the electronic health record (77%) than the academic (23%; P=0.002) and unaffiliated groups (0%; P<0.001). Finally, the unaffiliated group had a greater preference for fax (58%) than the other groups (both 0%; P<0.001).

“Our findings lead us to hypothesize that identifying and incorporating [primary care clinician] preferences may improve communication, though at the potential expense of standardization and efficiency,” the study authors wrote. They noted that the study's generalizability is limited by the low survey response rate and that the unaffiliated group was a convenience sample.