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Challenging the information gap – the patients transfer from hospital to home health care

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InternationalJournalofMedicalInformatics(2004)73,569—580

Challengingtheinformationgap—thepatients

transferfromhospitaltohomehealthcare

RagnhildHellesøa,*,MargaretheLorensena,LenaSorensenb

aFacultyofMedicine,InstituteofNursingandHealthSciences,UniversityofOslo,P.O.Box1153,

Blindern,OsloNO-0318,NorwaybSchoolofNursing,UniversityofColoradoHealthSciencesCenter,4200EastNinthAvenue,

Denver,CO80262,USA

KEYWORDS

Informationgap;

Continuityof

inter-organizational

care;

Safety;

Informationcontent;

Hospitaldischarge;

Homehealth

careSummaryThepurposeofthispaperistoidentifytheinformationthatnursesinhospitalsexchangewithnursesinhomehealthcare(HHC),andwhatnursesperceivetobethemostsignificantinformationtoexchange.Method:Nurseshaveanobligationtosupportandensurecontinuityofpatientcareandtopreventaninformationgapwhenpatientsaretransferredfromoneorganizationalofhealthcaredeliverytoanotherorganizationallevel,forexample,fromhospitaltohomehealthcare.Inanongoingprospectivestudy,nurses’pre-electronicnursingdischargenoteandtheirassessmentoftheinformationitwasnecessarytoexchangeatthesametimewasauditedandanalyzed.Theresultsshowvariationinthecompletenessandcontentofthenursingdischargenote.Nurses’understandingofthescopeandcontentofinformationtobetransmittedvarieswidelyaccordingtothecontextandtheorganizationalhealthcareleveltheyworkwithin.Theimplementationofanelectronicnursingdischargenotecreatestheopportu-nitytoidentifytheaccurateinformationelementsthatmustbedocumentedandexchangedbetweenthenursestoensurepatientsafetyandinter-organizationalcon-tinuityofcare.©2004ElsevierIrelandLtd.Allrightsreserved.

1.Introduction

Theprovisionofeffectiveandappropriatehealth

careisbecomingmoreandmorecomplexandcom-

plicated[1,2];challengesincludethefrequent,

rapidchangesinthepatternsofhealthservicede-

liveryandthechangingdemographicsofthepeo-

pleserved.Thepatientpopulationisincreasingly

*Correspondingauthor.Tel.:+4722850566;fax:+4722850570.E-mailaddress:ragnhild.helleso@medisin.uio.no(R.Hellesø).elderly;morepeoplearesufferingfromchronic

illness,yetthelengthofhospitalstayisdecreas-

ing,andanincreasingproportionofhealthcareis

providedasoutpatientcareand/orincommunity

healthcare[3,4].Manypatientswillexperience

oneormoretransitionsbetweencareproviders

duringthetrajectoryoftheirillness.Continuityof

patientcareisregardedasakeycomponentinen-

suringsafeandqualitycareforpatientsacrossall

healthcaredeliveryleveltransitions[5].Themod-

ernizationofhealthcarehas,however,resultedin

fragmentation,discontinuityincareanddifferen-

tiationofhealthcareorganizationsandprofessions

1386-5056/$—seefrontmatter©2004ElsevierIrelandLtd.Allrightsreserved.doi:10.1016/j.ijmedinf.2004.04.009570R.Hellesøetal.

[6].Hospitalandthecommunityhealthcaresystem

appeartohavedifferentandconflictingvaluesand

objectives[6—8].Atthesametimethehealthcare

authorities[9—11],looktotheprovidersandthe

patientsthemselvesfordevelopmentandenhance-

mentofcontinuityofpatientcareinthehealth

care[12—16].Thefragmentationandconflictscan

becomeathreattopatientsafetyandabarrier

toenhancinganddevelopingasystemofappro-

priatepatientcareacrossdifferentorganizational

levels.Patientshavereportedexperiencinggaps

anddiscontinuityintheirhealthcare,especiallyin

transitionsfromhospitaltoHHC[17].

Itisexpectedthattheadventandimplemen-

tationoftheelectronicpatientrecord(EPR)in

general,andspecifically,electronicdischargesum-

mary,willsimplifytheexchangeofinformation

betweenagenciesandimprovethequalityand

continuityofcare[9,18,19].Thenursingdischarge

notehasbeenidentifiedasasignificantcompo-

nentoftheEPR[20].Thepurposeofadischarge

noteistoexchangeinformationbetweenhealth

careprovidersinhospitalandcommunityhealth

care,aswellastobeatoolthatwillcontribute

tointer-organizationalcontinuityofcareandcom-

pensateforfragmentedhealthcare[21].

Informationtechnology(IT)providesthecapa-

bilitytocapture,store,andhandlevastamounts

ofinformation.Hannah[22]emphasizesthatthe

nursingprofessionhastoaddresstheessentialdata

needsofnursesinallpracticesettings.Soakey

questionarises:whatisthescope,levelofdetail,

andaccuracyofinformationtobeexchangedthat

contributestotheprovisionofeffectiveandap-

propriateinter-organizationalcontinuityofcare

forpatientswhoneedfollow-uphealthcareafter

theirdischargefromthehospital.

2.Theaim

Thedatausedforthispaperisasubsetofa

largerongoingpretest-posttestprospectivestudy.

Thedataandanalysispresentedhereisfromthe

pretest.Theaimofthispaperistoidentify(1)

theinformationnursesinhospitalexchangewith

thenursesinhomehealthcare(HHC)and(2)

whatnursesperceivetobethemostappropri-

ate/relevantinformationtoexchange.

3.Challengesinnurses’information

exchange

Therearetwomainobjectivesforfocusingon

nurses’exchangeofinformation:compliancewithhealth-carelegislation[23,24],andsafetyinhealth

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