[Interlevel incident management: The experience of a primary care district]

Abstract

Aim: Determine the prevalence and define the profile of interlevel incidences (ININ) between primary care (PC) and hospital (HC).

Design: Multicenter cross-sectional descriptive study. SITE: Primary care.

Participants: Professionals from a Health District and its reference hospitals.

Interventions: ININ are errors in communication between PC and HC professionals derived from administrative, pharmaceutical or clinical procedures not resolved during the formal interlevel communication processes, which requires a coordinated and validated response from the health care directions to not overload the family physician.

Main measurements: ININ by category, hospital services and health centers, total and validated, relative to the total number of referrals, and the reason for the ININ.

Results: We detected 2011 ININs (3.36%) among the 59.859 referrals, although only 1684 were validated (83.7%). Most were administrative (59.5%), followed by pharmaceutical (24.2%), clinical (10.2%) and reverse (6.1%). 41.3% of the clinical ININs were grouped around 5 hospital specialties, and 45.9% in 5 health centers. The main reasons for clinical ININ were non-prescription of the recommended pharmacological treatment in outpatient clinics or on hospital discharge (27.3%), request for referral to another hospital specialist (27.9%), or request to referral in person to patients who had already been referred by teleconsultation (17.8%).

Conclusions: 3.36% of interlevel referrals are accompanied by incidents and 83.7% are validated and processed. It is necessary to develop ININ management tools to guarantee safe healthcare and debureaucratize PC.

Keywords: Bureaucratization; Burocratización; Care continuity; Care coordination; Communication; Comunicación; Continuidad asistencial; Coordinación de cuidados.