Impact of a standardized communication system on continuity of care between family physicians and the emergency department

Abstract

ABSTRACT Objective: It has been suggested that continuity of care is hampered because of the lack of communication between emergency departments (EDs) and primary care providers. A web-based, standardized communication system (SCS) that enables family physicians (FPs) to visualize information regarding their patients' ED visits was developed. This paper aims to evaluate the impact of this SCS on continuity of care. Methods: We conducted an open, 4-period crossover, cluster-randomized controlled trial of 23 FP practices. During the intervention phase, FPs received detailed reports via SCS, while in the control phase they received mailed copies of the ED notes. Continuity of care was evaluated with a web questionnaire completed by FPs 21 days after the ED visit. The primary measures of continuity of care were knowledge of ED visit (quality and quantity), patient management and follow-up rate. Results: We analyzed a total of 2022 ED visits (1048 intervention and 974 control). The intervention group received information regarding the ED visit more often (odds ratio [OR] 3.14, 95% confidence interval [CI] 2.6–3.79), found the information more useful (OR 5.1, 95% CI 3.49–7.46), possessed a better knowledge of the ED visit (OR 6.28, 95% CI 5.12–7.71), felt they could better manage patients (OR 2.46, 95% CI 2.02–2.99) and initiated actions more often following receipt of information (OR 1.62, 95% CI 1.36–1.93). However, there was no significant difference in the follow-up rate at FPs offices (OR 1.25, 95% CI 0.97–1.61). Conclusion: The use of SCS between an ED and FPs led to significant improvements in continuity of care by increasing the usefulness of transferred information and by improving FPs' perceived patient knowledge and patient management.