Continuity of care in the transition from emergency department to general practitioner is it adequate?

Objective: To assess the adequacy of continuity of care for patients who are discharged to home or admitted to hospital from the emergency department. Methods: Questionnaire survey of emergency department communication practices. Results: Seventy-five of 86 emergency departments (87.2%) participated. Emergency departments failed to communicate with general practitioners upon disposition of many patients. For patients discharged to home, significantly more private emergency departments contacted general practitioners directly by telephone (P <0.01) or by letter (P <0.001). Significantly more public emergency departments gave patients a letter to take to their general practitioners (P <0.01). Overall, emergency departments gave the patient a general practitioner letter some (33.3% of emergency department) or most (40.0%) of the time. Few letters were posted or faxed and little use of Email was made. Pre-formatted letters were used less than was expected. On patient admission, the telephone was used most frequently to advise general practitioners. Conclusions: Continuity of patient care may be inadequate in many emergency departments. Emergency departments should establish a check system to ensure that a communication is made with the general practitioners of all patients. Telephone or facsimile communication is recommended on patient admission. Other modes may be more appropriate on patient discharge to home. Structured, pre-formatted letters/facsimiles are recommended. Emergency department-general practitioner communications should be used as a performance indicator of emergency department practice.