Malpractice fears hamper communication between ED physicians and PCPs

If one of your patients is treated in a hospital emergency department (ED), chances are you engage in very little communication or coordination of care with the doctors who provided the care. So says a new study conducted by the Center for Studying Health System Change (HSC) for the nonprofit National Institute for Health Care Reform (NIHCR).

The result, the study’s authors conclude, is compromised patient care. It’s a problem for which no simple solutions are evident.

“There are no easy answers to the coordination issues between emergency and primary care physicians,” says Emily Carrier, MD, MSCI, HSC senior researcher and coauthor of the study. “Policymakers will need to examine a broad range of ways to address the problem. Pieces of the puzzle include payment reforms, standards for health information technology and malpractice liability reform.”

The researchers conducted 42 phone interviews with 21 pairs of ED physicians and PCPs, case-matched so that the perspectives of both specialties were represented. The key findings:

• Real-time communication could be useful in many cases, but would be particularly time-consuming.

• Faxing patient information could be helpful, but has limitations.

• Sharing information via interoperable electronic health records would overcome some barriers. However, this option doesn’t offer a rapid overview of a patient’s case, limiting access to the kinds of detail an ED provider might need to direct care.

• Insufficient time and lack of reimbursement are significant barriers to communications between the two groups.

• When cross-covering physicians are involved, an ED physician is less likely to speak with a PCP who has direct knowledge of the patient.

• The increasing use of hospitalists and larger primary care groups decreases the interactions between office-based providers and prevents PCPs from fully participating in care coordination.

Researchers concluded that even if these barriers to communication and coordination were removed, vexing liability concerns would remain. ED and primary care physicians face different constraints and have “fundamentally different assumptions regarding patients’ reliability and resilience,” according to the study.

Unlike PCPs, ED physicians do not have the opportunity to develop long-term relationships with patients, which are considered to be the most effective protection against being sued in the event of a misdiagnosis or bad outcome. ED physicians generally are much more concerned about being sued than primary care physicians, say the researchers.

Failing to address emergency providers’ concerns about their malpractice liability will limit attempts to encourage ED physicians to coordinate with PCPs, the study concluded. Moreover, even if an ED physician could reach a patient’s PCP and even if the PCP proposed an alternative to testing or admission recommended by the emergency provider, that provider would likely have to accept the full legal responsibility should there be a bad outcome following the patient’s discharge.

So what can you do? At the very least, let your patients know that you want to be able to follow up after any hospital visit. Ask patients to notify you themselves and to list you on the follow-up note at the ED.