OBJECTIVE: To determine the prevalence of medical errors related to the discontinuity of care from an inpatient to an outpatient setting, and to determine if there is an association between these medical errors and adverse outcomes.
PATIENTS: Eighty-six patients who had been hospitalized on the medicine service at a large academic medical center and who were subsequently seen by their primary care physicians at the affiliated outpatient practice within 2 months after discharge.
DESIGN: Each patient’s inpatient and outpatient medical record was reviewed for the presence of 3 types of errors related to the discontinuity of care from the inpatient to the outpatient setting: medication continuity errors, test follow-up errors, and work-up errors.
MEASUREMENTS: Rehospitalizations within 3 months after the initial postdischarge outpatient primary care visit.
MAIN RESULTS: Forty-nine percent of patients experienced at least 1 medical error. Patients with a work-up error were 6.2 times (95% confidence interval [95% CI], 1.3 to 30.3) more likely to be rehospitalized within 3 months after the first outpatient visit. We did not find a statistically significant association between medication continuity errors (odds ratio [OR], 2.5; 95%CI, 0.7 to 8.8) and test follow-up errors (OR, 2.4; 95%CI, 0.3 to 17.1) with rehospitalizations.
CONCLUSION: We conclude that the prevalence of medical errors related to the discontinuity of care from the inpatient to the outpatient setting is high and may be associated with an increased risk of rehospitalization.
medical errors continuity of care discharge plan discharge summary
Petersen LA, Brennan TA, O’Neil AC, Cook EF, Lee TH. Does housestaff discontinuity of care increase the risk for preventable adverse events? Ann Intern Med. 1994;121:866–72.PubMedGoogle Scholar
Petersen LA, Orav EJ, Teich JM, O’Neil AC, Brennan TA. Using a computerized sign-out program to improve continuity of inpatient care and prevent adverse events. Jt Comm J Qual Improv. 1998;24:77–87.PubMedGoogle Scholar
Kohn LT, Corrigan JM, Donaldson MS. To Err is Human: Building a Safer Health System. Washington, DC: Institute of Medicine, National Academy Press; 2000.Google Scholar
Mageean RJ. Study of “discharge communications” from hospital. Br Med J (Clin Res Ed). 1986;293:1283–4.Google Scholar
Wilson S, Ruscoe W, Chapman M, Miller R. General practitioner-hospital communications: a review of discharge summaries. J Qual Clin Pract. 2001;21:104–8.PubMedCrossRefGoogle Scholar
Fair JF. Hospital discharge and death communications. Br J Hosp Med. 1989;42:59–61.PubMedGoogle Scholar
van Walraven C, Seth R, Austin PC, Laupacis A. Effect of discharge summary availability during postdischarge visits on hospital readmission. J Gen Intern Med. 2002;17:186–92.PubMedCrossRefGoogle Scholar
Diem SJ, Prochazka AV, Meyer TJ, Fryer GE. Effects of a postdischarge clinic on housestaff satisfaction and utilization of hospital services. J Gen Intern Med. 1996;11:179–81.PubMedCrossRefGoogle Scholar
Elmore JG, Feinstein AR. A bibliography of publications on observer variability (final installment). J Clin Epidemiol. 1992;45:567–80.PubMedCrossRefGoogle Scholar
Wachter RM. An introduction to the hospitalist model. Ann Intern Med. 1999;130:338–42.PubMedGoogle Scholar
Hayward RA, Hofer TP. Estimating hospital deaths due to medical errors: preventability is in the eye of the reviewer. JAMA. 2001;286:415–20.PubMedCrossRefGoogle Scholar
Thomas EJ, Studdert DM, Brennan TA. The reliability of medical record review for estimating adverse event rates. Ann Intern Med. 2002;136:812–6.PubMedGoogle Scholar
Palmer HC, Armistead NS, Elnicki DM, et al. The effect of a hospitalist service with nurse discharge planner on patient care in an academic teaching hospital. Am J Med. 2001;111:627–32.PubMedCrossRefGoogle Scholar
Craig DE, Hartka L, Litosky WH, Caplan WM, Litsky P, Smithey J. Implementation of a hospitalist system in a large health maintenance organization: the Kaiser Permanente experience. Ann Intern Med. 1999;130:355–9.PubMedGoogle Scholar
Hackner D, Tu G, Braunstein GD, Ault M, Weingarten S, Mohsenifar Z. The value of a hospitalist service: efficient care for the aging population? Chest. 2001;119:580–9.PubMedCrossRefGoogle Scholar
Davis KM, Koch KE, Harvey JK, Wilson R, Englert J, Gerard PD. Effects of hospitalists on cost, outcomes, and patient satisfaction in a rural health system. Am J Med. 2000;108:621–6.PubMedCrossRefGoogle Scholar
Molinari C, Short R. Effects of an HMO hospitalist program on inpatient utilization. Am J Manag Care. 2001;7:1051–7.PubMedGoogle Scholar
Auerbach AD, Nelson EA, Lindenauer PK, Pantilat SZ, Katz PP, Wacher RM. Physician attitudes toward and prevalence of the hospitalist model of care: results of a national survey. Am J Med. 2000;109:648–53.PubMedCrossRefGoogle Scholar
Pantilat SZ, Lindenauer PK, Katz PP, Wachter RM. Primary care physician attitudes regarding communication with hospitalists. Dis Mon. 2002;48:218–29.PubMedCrossRefGoogle Scholar
Simon SR, Lee TH, Goldman L, McDonough AL, Pearson SD. Communication problems for patients hospitalized with chest pain. J Gen Intern Med. 1998;13:836–8.PubMedCrossRefGoogle Scholar
Schroeder SA, Schapiro R. The hospitalist: new boon for internal medicine or retreat from primary care? Ann Intern Med. 1999;130:382–7.PubMedGoogle Scholar
Iwashyna TJ, Curlin FA, Christakis NA. Racial, ethnic, and affluence differences in elderly patients’ use of teaching hospitals. J Gen Intern Med. 2002;17:696–703.PubMedCrossRefGoogle Scholar
Cornelius LJ. The degree of usual provider continuity for African and Latino Americans. J Health Care Poor Underserved. 1997;8:170–85.PubMedGoogle Scholar
Gaskin DJ, Hoffman C. Racial and ethnic differences in preventable hospitalizations across 10 states. Med Care Res Rev. 2000;57(suppl 1):85–107.PubMedCrossRefGoogle Scholar