Coordination Between Emergency and Primary Care Physicians

Coordination between emergency department physicians and primary care physicians remained a significant gap in the American health care system, with fragmented communication contributing to duplicated services, missed follow-up care, and poor health outcomes for patients, according to research from the Center for Studying Health System Change (HSC). As emergency departments increasingly served as the entry point for uninsured and underserved patients -- and as care coordination gained prominence as a policy priority -- the disconnect between emergency and primary care settings demanded attention.

The Coordination Challenge

When patients visited emergency departments for conditions related to chronic illness, mental health crises, or exacerbations of ongoing conditions, the information generated during the ED visit often failed to reach the patient's primary care physician in a timely or useful manner. Discharge summaries were inconsistently transmitted, follow-up instructions were not communicated, and medication changes made in the ED were not reflected in the primary care record. This breakdown in communication could lead to medication errors, missed diagnoses, and patients falling through the cracks between episodes of care.

The problem was compounded by the reality that many frequent ED users lacked established primary care relationships. Without a medical home to receive and act on ED visit information, the coordination challenge became moot -- there was no downstream provider to coordinate with. Connecting these patients to ongoing primary care remained a prerequisite for meaningful emergency-primary care coordination.

Promising Approaches

Several approaches showed promise in bridging the gap. Health information technology, including shared electronic health records and automated notification systems, could facilitate real-time information sharing between emergency and primary care settings. Some communities had implemented ED notification systems that alerted primary care physicians when their patients visited an emergency department, enabling proactive follow-up and care plan adjustments.

Patient-centered medical home models, which emphasized care coordination and after-hours access, offered another approach by reducing unnecessary ED visits and strengthening the primary care-ED linkage for patients who did require emergency services. Community health workers and care coordinators positioned at the interface between emergency and primary care settings could also help patients navigate between the two systems, ensuring follow-up appointments were scheduled and attended.

Effective coordination between emergency and primary care physicians required both technological infrastructure and cultural change within both settings. Emergency physicians needed to view information sharing as a core professional responsibility, while primary care physicians needed to actively integrate ED visit information into their care of patients. Payment models that rewarded coordination rather than volume could help create the incentives needed to make these behavioral changes stick.

Sources and Further Reading

HSC research on coordination between emergency and primary care physicians, based on Community Tracking Study data and related analyses.