Similar to the dramatic rift we recently reported in communication between primary care physicians (PCPs) and specialists, a new study shows that PCPs also frequently fail to coordinate care with emergency department (ED) doctors.

Last year, researchers from the Center for Studying Health System Change (HSC) interviewed 21 pairs of ED physicians and PCPs who practiced at the same hospital in 12 communities across the country, and discovered several recurrent breakdowns in communication. For example, it was common for a PCP to refer a patient to the ED without sending pertinent chart information. Working blindly, ED physicians would often duplicate tests and procedures already performed by a PCP.

The study, conducted for the nonprofit National Institute for Health Care Reform, suggested several structural changes in medicine that have contributed to the problem, including the increased use of hospitalists and hospitals and PCPs using electronic health records that don't talk to each other. And of course, busy physicians are not reimbursed for the time required to discuss follow-up care for a patient leaving the ED, researchers noted.

Authors recommended the following steps to improve teamwork between PCPs and ED physicians:

• Communitywide networks of interoperable EHRs among providers
• Revision of federal incentives for meaningful use of EHRs could to reward data sharing between treating providers
• Rewarding physicians and hospitals for controlling the utilization of services by working together
• Medical liability reform to give EDs a 'safe harbor' from malpractice claims if they coordinate patient care with their PCP colleagues

To learn more:
- read the article in Medscape Today (reg. required)
- see the study from the NIHCR

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