Hospital Registration:  Step 1 in Transition of Care

When a patient registers at the hospital, is the patient’s regular doctor identified and recorded accurately?  Effective transition of care would dictate that this information is essential for the hospital to communicate care instructions to the right primary care provider in a timely manner.  This is where much of the breakdown occurs.  In recent hospital engagements, I found that of the patients discharged from the ED, 50-70% do not have a primary care doctor listed in their record.  In these cases, the information about the hospital stay cannot follow the patient to their next point of care. 

Nationally, most PCPs don’t have the information they need to treat patients post-discharge:  Only 12-34% of doctors receive timely discharge summaries by the time patients make their first post-discharge visits.  (Journal of the American Medical Association, 2007)

If the patient does not have a primary care physician, there is a missed opportunity to connect them with one.  Hospitals should provide referral services to assist patients in finding primary care providers.  Connecting patients to primary care  is shown to reduce unnecessary, expensive, and often unreimbursed visits to the hospital ED  (CDC).  For uninsured patients that present without a regular doctor, there is an opportunity to direct them to safety net clinics, if available (in Raleigh, we have the Capital Care  Collaborative ).  

Collecting this information is also good business.  Hospital-physician relations are impeded if the hospital cannot track referral patterns.  Connecting patients to external providers is key to a hospital’s business development effort.  Doctors have choices.  As hospitals compete for the most profitable patients in their communities, they must give referring doctors every reason to send patients to their institution.

But none of this is possible if a doctor’s name is not captured at the time of patient registration.

Once a light is shone on this aspect of the hospital registration process, regular training with the registration staff is necessary to reinforce new behavior.  The hospital may find that it needs to make some minor modifications to its information systems to make this data entry simpler - with accurate and complete drop-down lists of all community practices and providers listed.  Metrics can be collected to provide incentives to those that consistently collect this information. 

As hospital and physician reimbursement is increasingly determined by things that are closely linked with patient outcomes, low hospital readmissions, and fewer medical errors, the effective hand-off from hospital to primary care physician becomes essential.  It cannot happen if the hospital patient record is not linked to a primary care physician.  This connection needs to happen at registration.