What can artefact analysis tell us about patient transitions between the hospital and primary care? Lessons from the HANDOVER project

Figures & data

Figure 1. Artefact analysis - from the pilot study site in the United States.

Table 1. Summary of Results of the HANDOVER project related to different phases of the patient care process.

	Process of patient admission, hospitalization, and discharge
	Patient admitted to the hospital	Inpatient stay	Discharge community care setting	Follow up in the
Italy^a	Patient assessment in the Emergency Department.	Medical referral during inpatient stay.	One copy of discharge letter to hospital, one copy to GP after discharge.	Additional consultancy requested from cardiologist.
	Diagnostic consultancy in the Emergency Observation Unit.	Plan of nursing care. Documented prescribed and administered drugs during inpatient stay.
Netherlands^a	Notification of planned intervention sent to GP Patient prepares admission questionnaire, including list of current information.	Procedure cancelled because patient had not stopped anti-coagulation therapy.	Discharge report does not specify why patient's procedure was cancelled.	GP refers patient to hospital with same physical complaints as first admission.
Poland^a	Lack of specialized consultation and diagnostic tests in the referral from the GP.	No direct contact between the hospital and the GP.	Chart contains description of patient stay, test results, planned time of surgical consultation after discharge, medications, and recommendations for the patient.	Patient responsible for the flow of information between the hospital and GP.
Spain^b	Hospital has access to primary care files, if patient is in the same geographical area under the same provider network.	Patient brings records of previous hospital admissions (planned and emergency).	Hospital prepares detailed medical and nursing discharge report and files are stored in as PDF files.	Patient is the ‘postman’ delivering discharge records to the primary care physician. In some primary care centres the discharge notes are available electronically as well.
Sweden^a	Shared IT system between Advanced Home Care, hospital, and ambulance.	Web care (electronic nursing care system) was not used.	No evidence of a nursing discharge report.	Follow up on lung function not scheduled until much later than planned.
		(Web care is considered best practice).	Primary care physician did not receive discharge summary.	Advanced Home Care performs its own follow up on electronic notes the day after discharge.

^aIndividual patient level process.

^bSystem level process.

Figure 2. Artefact analysis - from an academic centre in Sweden.