Abstract
IntroductionApproximately two-thirds of the patients admitted to the hospital with an ischemic stroke are discharged directly home. Discontinuity of care may result in avoidable patient harm, re-admissions and even death. We hypothesized that the transfer of information is most essential in this patient group since any future care for these patients relies solely on the information that is available to the care provider responsible at that time.AimThe objective of this study was to evaluate the continuity of transmural care in ischemic stroke patients by assessing 1) the transfer of clinical information through discharge letters to general practitioners (GPs), 2) subsequent documentation of this information and early follow-up by GPs and 3) the documentation of medication-related information in discharge letters, at GPs and community pharmacies (CPs).MethodsThis prospective cohort study was conducted from September 2019 through March 2020 in OLVG, Amsterdam, the Netherlands, in patients with a first stroke discharged directly home. Outcome measures were derived from national guidelines and regional agreements. Results were analyzed using descriptive analysis.ResultsA total of 33 patients were included. Discharge letters (n = 33) and outpatient clinic letters (n = 24) to GPs contained most of the essential items, but 16% (n = 9) of the letters were sent in time. GPs (n = 31) infrequently adhered to guidelines since 10% (n = 3) of the diagnoses were registered using the correct code and 55% (n = 17) of the patients received follow-up shortly after discharge. Medication overviews were inaccurately communicated to GPs since 62% (n = 150) of all prescriptions (n = 243) were correctly noted in the discharge letter. Further loss of information was seen as only 39% (n = 95) of all prescriptions were documented correctly in GP overviews. We found that 59% (n = 144) of the prescriptions were documented correctly in CP overviews.ConclusionIn this study, we found that discontinuity of care occurred to a varying extent throughout transmural care in patients with a first stroke who were discharged home.
Highlights
Two-thirds of the patients admitted to the hospital with an ischemic stroke are dis‐ charged directly home
Discharge letters (n = 33) and outpatient clinic letters (n = 24) to General practitioner (GP) contained most of the essential items, but 16% (n = 9) of the letters were sent in time
We found that 59% (n = 144) of the prescriptions were documented correctly in Community pharmacy (CP) overviews
Summary
Two-thirds of the patients admitted to the hospital with an ischemic stroke are dis‐ charged directly home. Two-thirds of the patients admitted to the hospital with an ischemic stroke are discharged directly home [1]. These patients no longer receive continuous care from inpatient healthcare professionals as they are transferred back to primary care. To guarantee continuity of care in this group of patients, timely and accurate communication to the care providers is essential. Discontinuity was shown in the transfer of medication-related information to GPs and CPs, which could result in medication-related problems [3, 5,6,7,8,9]
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