Tying Up Loose Ends

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Abstract
The high incidence of medical errors cited in the Institute of Medicine's report, To Err Is Human,1 may underestimate the overall extent of the patient safety problem in the United States. The Institute of Medicine's report did not address errors that occur during the transition of patient care from the hospital to the outpatient setting. Studies by Forster et al2-4 show that between 19% and 23% of patients who were recently hospitalized experienced an adverse event after discharge. Many of the adverse events described in the studies by Forster et al were due to inadequate postdischarge follow-ups for patients' unresolved medical problems. With the introduction of prospective payment systems to hospitals, patients are being discharged from the hospital “quicker and sicker”5(p1980); therefore, outpatient follow-ups for patients' unresolved medical problems are becoming an increasingly important component of patient safety. Postdischarge follow-up evaluations for patients are commonly outlined by hospital physicians in discharge summaries, and the discharge summary has traditionally been the means by which informational continuity6 between hospital physicians and primary care physicians (PCPs) is maintained. Inpatient-to-outpatient informational continuity, usually in the form of the discharge summary, is the common thread ensuring that patient care is appropriately transitioned between hospital physicians and outpatient PCPs. However, few PCPs ever receive these discharge summaries prior to their patients' initial postdischarge visits.7,8 In addition, discharge summaries often lack sufficient information required for PCPs to adequately address patients' unresolved medical problems.9-11