Study: Poor hospital-home health communication puts patients at risk

More than half of Colorado home health care clinicians say they have received insufficient information from hospitals to guide patient management, according to a new statewide survey.

In the survey of home health care nurses and staff, conducted by researchers at the University of Colorado Anschutz Medical Campus, 60 percent of respondents indicated they had not received enough information to guide patient treatment, while 44 percent reported encountering problems related to inadequate patient information.

“We have heard of medication errors occurring between hospitals and home healthcare providers,” says Christine Jones, MD, assistant professor at the University of Colorado School of Medicine. “As a result, patients can receive the wrong medication or the wrong dose. Some home health providers don’t get accurate information about how long to leave a urinary catheter or intravenous line in.”

“Additional tests recommended by hospital clinicians was the communication domain most frequently identified as insufficient (58 percent),” states a study published on Monday in the Journal of the American Medical Directors Association. “More than half of respondents (52 percent) indicated that patient preparation to receive HHC was inadequate, with patient expectations frequently including extended-hours caregiving, housekeeping, and transportation, which are beyond the scope of HHC.”

Overall, researchers concluded that communication between hospitals and home healthcare was suboptimal and that patients are “often not prepared to receive (home healthcare)” when they are discharged from an acute care setting.

However, the survey found that respondents with electronic health record access for referring providers were less likely to encounter problems related to a lack of information (27 percent vs. 57 percent without EHR access). In addition, those surveyed with EHR access were also more likely to have sufficient information about medications and contact isolation.

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As a result, the study’s authors concluded that providing EHR access for home health care clinicians is a “promising solution” to improve the quality of communication with hospitals.

“Almost all (96 percent) indicated that Internet-based access to a patient’s hospital record would be at least somewhat useful,” says Jones, the study's lead author. “However, fewer than half reported having access to EHRs for referring hospitals or clinics.

“For hospitals and HHC agencies seeking strategies to improve communication, this study can provide targets for improvement," she adds. “Future interventions to improve communication between the hospital and HHC should aim to improve preparation of patients and caregivers to ensure they know what to expect from HHC and to provide access to EHR information for HHC agencies.”