Safe Transitions of Care: Primary Care Practice

1
Safe Transitions of Care Primary Care Practice

• Nancy Elder, MD, MSPH
• Debbie Graham, MSPH
• John Hickner, MD, MS
• American Academy of Family Physicians
• 2004 NPSF Lets Get On With It!
• May 3-7, 2004

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Event Report 1

• 48 year old female with carcinoid syndrome.
  Tumor has not been found as of yet. Discussed
  patient with specialist who agreed to "get her in
  quickly." I am now seeing patient back several
  weeks later and patient has had no contact from
  specialist. Luckily, patient has been relatively
  asymptomatic during the time period. However this
  delay could have led to a worsening of symptoms.
  Contributing factors include poor communication
  from specialist to his scheduling staff, possibly
  specialist "forgot." Further records were sent
  to "remind" specialist--perhaps they were not
  received.

3
Event Report 2

• Primary care physician wrote referral for 68
  year old female patient to see a specialist. The
  specialist has a very common last name and no
  first name was provided. There were two other
  doctors with the specialist's last name in our
  area. Resulted in delay in entering referral for
  patient who needed to be seen asap due to chest
  pain. Specialist's office could refuse to see
  patient until referral was received.
  Contributing factors include physician may have
  been writing referral while in the room with
  patient and did not have access to specialist
  information.

4
Event Report 3

• 11 year old male patient recently hospitalized
  for aplastic crisis secondary to sickle cell,
  seen today for follow-up--no discharge summary.
  Time spent obtaining the information delayed
  patient interaction. If the discharge summary
  had ultimately been unavailable during visit it
  would have undermined patient care. Contributing
  factors include poor transfer of information
  between hospital and office.

5
Event Report 4

• 48 year old female patient here for follow-up.
  My office had received call from cardiologist
  that she had abnormal labs which needed to be
  followed up. However, no communication from
  cardiologist to my office, therefore no lab
  results to discuss. Consequences call placed
  to cardiology office, unable to reach person who
  could provide information, patient rescheduled
  for later appointment. Contributing factors as
  the information should have come from another
  office to ours, it is unclear what happened on
  their end.