Capital District Health Authority

  • Stephanie Connidis, Service Chief, Community Health Unit (8.4 Halifax Infirmary), Capital District Health Authority, Halifax, Nova Scotia
  • Sandra Janes, Director, Health Services, Medicine, Geriatrics and Emergency, Capital District Health Authority, Halifax, Nova Scotia 
  • Stavros Savvopoulos, Medical Director, Hospital Care and Chief of Family Practice, QE II Site, Capital District Health Authority, Halifax, Nova Scotia 

A Process to Improve Quality and Timeliness of Information Transfer between Inpatient and Primary care Physicians at Hospital Discharge – Implications for Continuity of Care

Our current practices used to transition patient care at discharge do not reflect the evidence, medical-legal recommendations and technology available to ensure our patients receive safe continuity of care in the community.

Our objective is to improve transitions of care at the point of hospital discharge by providing legible, relevant and timely information through the implementation of a standardized electronic discharge (e-discharge) summary. This incorporates a clearly defined handover for follow up investigations/consultations and appointments, utilizes an automatic risk prediction model and is disseminated at the time of discharge. We can study the impact of combining such a risk assessment with a built-in decision making function that prompts the user to communicate with the primary care physician (PCP) and/or negotiate an early follow up appointment on reducing readmission rates and improved safety for high-risk patients.

The intervention is also designed to reduce errors of clinical coding/abstracting by improving the quality of the source documentation from which the coding data are extracted. Moreover, it involves a renewed process for distribution of completed discharge summaries in conjunction with the electronic medication reconciliation (e-DMR) to allow timely and legible information delivery to PCPs. The content relevance, conciseness of the information included in the new discharge summary, and timeliness of discharge summary receipt by the PCP are all aspects that will require evaluation. 

Further improving the userability of the tool including: adapting features, integrating it with broader systems, applying a similar format to other transition points and adding standards for clinical coding are achievable short term targets as we move to the desired state of a full e-HR. We are confident that the experience from our intervention is also an exercise of preparation for the organization to move closer to this goal.  

The early success of this project is considered to be a result of the collaborative efforts of CDHA leadership, clinicians and support departments (specifically: IT, e-Health, Pharmacy, Performance Excellence, Legal, District Medical Advisory Committee), PCPs and its alignment with organizational priorities, Accreditation Canada ROP’s and CMPA recommendations. In our academic setting most discharge summaries are completed by house staff (learners) or nurse practitioners and verified by attending staff physicians. Regulations are in place for attending physicians to approve final summaries and dictations before they are sent out to PCPs, however there are many deficiencies requiring follow up by e-Health. As this project progresses, resources are being leveraged to improve the noted deficiencies.

Challenges our district faces in relation to PCPs resisting the use of fax machines limits the autofax transmission modality of this project. Our relationships with District Department of Family Practice, Doctors NS and the leadership of our VP Medicine has had early success in developing sustainable procedures and processes to help reconcile and centralize physician contact information strengthening our compliance with the revised Privacy Information Act - PHIA. As PHIA rolls out, CDHA Privacy office has committed to staying in touch around this project to ensure compliance with the legislation.