Keywords

Ambulatory/physician office, Continuum of care, Discharge planning, Error/adverse events, Incident classification systems, Near misses/error reporting, Patient safety

Authors

1. Trompeter, Jessica M.
2. McMillan, Ashlee N.
3. Rager, Michelle L.
4. Fox, Jeremy R.

Abstract

Purpose: Concerns surround discontinuity of care and poor communication during transitions of care between inpatient and outpatient settings. This study was designed to examine the differences in medication discrepancies during these transitions between an outpatient clinic with admitting privileges (PCP-AD) and another without admitting privileges (PCP-NOAD).

Methods: Retrospective, chart review of patients admitted to the hospital between January and July 2009, who stated their primary care provider (PCP) was from either one of the outpatient clinics. Charts were evaluated for medication discrepancies on admission and discharge and follow-up with PCP after discharge.

Results: On both admission and discharge, PCP-AD had a rate of unacceptable discrepancies less than that of PCP-NOAD, 63.4% versus 90.3% (p < .001) and 44.9% versus 84.1% (p < .001) respectively. Patients prescribed more than 10 medications were more likely to have a medication discrepancy compared with those on fewer medications (p = .003). Additionally, 85% of patients from PCP-AD followed up after discharge compared with 62.7% from PCP-NOAD (p < .001).

Conclusions: The differences between the two groups in medication discrepancies and follow-up are suggestive of increased continuity of care with fewer discrepancies when PCPs are directly involved in inpatient care. A comprehensive and accurate medication history is imperative regardless of practice model.