Searching for the missing pieces between the hospital and primary care: mapping the patient process during care transitions

Julie K Johnson, Jeanne M Farnan, Paul Barach, Gijs Hesselink, Hub Wollersheim, Loes Pijnenborg, Cor Kalkman, Vineet M Arora, HANDOVER Research Collaborative

Research output: Contribution to journalArticlepeer-review

46 Citations (Scopus)


BACKGROUND: Safe patient transitions depend on effective communication and a functioning care coordination process. Evidence suggests that primary care physicians are not satisfied with communication at transition points between inpatient and ambulatory care, and that communication often is not provided in a timely manner, omits essential information, or contains ambiguities that put patients at risk.

OBJECTIVE: Our aim was to demonstrate how process mapping can illustrate current handover practices between ambulatory and inpatient care settings, identify existing barriers and facilitators to effective transitions of care, and highlight potential areas for quality improvement.

METHODS: We conducted focus group interviews to facilitate a process mapping exercise with clinical teams in six academic health centres in the USA, Poland, Sweden, Italy, Spain and the Netherlands.

FINDINGS: At a high level, the process of patient admission to the hospital through the emergency department, inpatient care, and discharge back in the community were comparable across sites. In addition, the process maps highlighted similar barriers to providing information to primary care physicians, inaccurate or incomplete information on referral and discharge, a lack of time and priority to collaborate with counterpart colleagues, and a lack of feedback to clinicians involved in the handovers.

CONCLUSIONS: Process mapping is effective in bringing together key stakeholders and makes explicit the mental models that frame their understanding of the clinical process. Exploring the barriers and facilitators to safe and reliable patient transitions highlights opportunities for further improvement work and illustrates ideas for best practices that might be transferrable to other settings.

Original languageEnglish
Pages (from-to)i97-105
JournalBMJ Quality & Safety
Volume21 Suppl 1
Publication statusPublished - Dec 2012
Externally publishedYes


  • Communication
  • Continuity of Patient Care
  • Cooperative Behavior
  • Europe
  • Focus Groups
  • General Practitioners
  • Humans
  • Institutional Management Teams
  • Interprofessional Relations
  • Interviews as Topic
  • Medical Staff, Hospital
  • Patient Admission
  • Patient Discharge
  • Patient Handoff
  • Primary Health Care
  • Process Assessment (Health Care)
  • United States


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