Information Transfer Between Primary and Secondary Care
Best practice and recommendations to initiate improvements in communication
The transfer of information between primary and secondary care in regards to patient referral and discharge, and solutions, strategies and training initiatives surrounding this were among the important themes emerging from an interesting study we recently sponsored which has just been published.
The main aim of the project was to investigate experiences of clinical incidents in healthcare settings from the perspectives of both healthcare professionals and patients, and determine key strategies for improving healthcare services and transitions in care.
In a 2016 report, Medisec, in collaboration with Healthcare Consultant Mary Culliton, identified the key risks for GPs and were keen to further explore the main risks arising from the interaction between hospitals, GPs and pharmacists at the points of a patient’s admission to, and discharge from, hospital.
The study, a collaboration between Medisec and the University of Limerick Hospitals Group, was based in the Mid-West, with healthcare professionals from primary care sites (GP practices and pharmacies) and secondary care hospitals. The steering group included representatives from the State Claims Agency (SCA), Health Information and Quality Authority (HIQA), Irish College of General Practitioners (ICGP), School of Pharmacy Trinity College Dublin, Schools of Medicine: University of Limerick (UL) and University College Dublin (UCD), Medical Council, World Health Organisation (WHO) Patients For Patients’ Safety, Health Service Executive (HSE), UL Hospitals. The project was managed by Ms Culliton and UL Researcher Dr Dorothy Leahy PhD.
The lead investigator was Clinical Director at UL Hospitals Dr John Kennedy. Academic support was provided by Professor Walter Cullen UCD, Professor Paul Finucane and Dr Dorothy Leahy, UL Hospitals.
Semi-structured interviews were conducted with healthcare professionals including GPs, pharmacists, consultants, hospital doctors, nurses and administration staff and a focus group with patients from primary and secondary care.
The analysis of participant data illustrated the following:
- Medication error was the most predominant risk highlighted among healthcare professionals. The report recommends that to decrease the risk of medication error, electronic information sharing practices be synchronised across primary and secondary care.
- Current referral pathways to hospital are complex and conflicting views among healthcare professionals on appropriate referral routes were apparent. The report recommends clearer referral pathways and support for healthcare professionals from primary and secondary care, in terms of providing more resources in units such as the MAU, AMAU and the LIU.
- While most GPs use IT based systems in their practices, paper based systems are still creating barriers in communication between primary and secondary care. Healthcare professionals in both sectors are receiving handwritten referral and discharge letters, with limited and in some cases illegible patient information. The report recommends a long-term solution – syncing IT systems across primary and secondary care and greater use of electronic communication, including the usage of ‘healthmail’ an email system that allows all hospitals to communicate clinical information securely to GPs.
- Healthcare professionals requested, and the report recommends, the expansion of the role of the hospital pharmacist. Increasing the number of hospital pharmacists at ward level and encouraging more collaboration with other healthcare professionals from primary and secondary care could reduce the risk of medication error.
- Patients want to be empowered. The report recommends, where possible, patients can access their own medical notes, to promote patient inclusion in their own healthcare and to facilitate better patient communication, education and awareness.
The objective of the steering group is to use the findings of the report to initiate improvements in the communication between primary and secondary healthcare sectors. There is continued collaboration of the agencies involved to action the recommendations identified and we, in Medisec, are committed to supporting the process.