Cardiac-rehab reports often don’t reach the primary-care doc


The news release posted below is a true problem, and a problem with the health care delivery system. Having spent many years working within the field I can testify there is a break down in communication and information sharing that occurs and electronic medical record are not the answer. I have had physicians (both primary care and cardiologist) request we do not send them reports, because they are bogged down with them and won’t read them anyway. Yet from the health care delivery stand point there must be a trail of documentation to support the delivery of services to allow reimbursement for your services. Another concern from the physician standpoint is who is responsible for acting on issues without stepping on the toes of the other health care providers…Yep a turf war.

So how is the best way to ensure your physicians stay actively involved in your heart recovery?

  • Hand carry the reports if able to your physician
  • Ask your physician to review the reports with you
  • Question the data provided – what does it mean, how does it compare with previous reports
  • Be an active consumer not passive

Yes your physician will hate it, as you are requiring more of their time, you probably learned some information from the internet – God Forbid – and  that you have an opinion. Not every physician responds this way, some are learning to embrace the empowered and educated patients as well as the use of technology, but many despise it due to time constraints.

Many times the issues found during rehabilitation should be addressed promptly, yet it can take months to get in with cardiology unless it is emergent. I can’t tell you how many times cardiology offices would tell me to send the patient to the ER as it was the quickest way to get the issues addressed, yet the patients were stable and didn’t require ER services, instead they needed consultation and medical management to prevent the problems from being life threatening.

One physician I worked with got annoyed with me for highlighting the pertinent  facts on the reports I would send over. I knew he wouldn’t take the time to read the report unless I used highlighter, red ink, urgent notice, immediate response required notices etc….and still to would not get responses. This is due to the health care delivery system. My belief is the use of more mid level providers to review records, determine course of action, follow up with the issues…and this is more necessary with electronic records.

Electronic records are wonderful, they allow the practitioners to follow the course of care, the issues that arose and the care received. However access is limited on a need to know basis and thus health care practitioners are not allowed to access records which may have very detailed pertinent information that will effect the delivery. There needs to be time and access for chart review.

Toronto, ON - The discharge summaries that should follow patients from cardiac rehabilitation to their primary-care providers, who use them for planning continued care, don’t reach the intended person about half the time, a prospective study suggests [1]. The summaries that do reach primary-care providers, moreover, often are missing key information on patient medications and clinical status, according to the authors, led by Peter A Polyzotis (York University, Toronto, ON).

“Although more clinical evidence supporting the effects of [cardiac-rehabilitation] summary transmission is needed, results suggest that more standardized strategies for [cardiac-rehabilitation] summary information gathering, generation, and transmission are required,” the group writes in a report published online January 8, 2013 in Circulation:Cardiovascular Quality and Outcomes.

In this study, conducted between September 2008 and March 2011, a survey was sent to a sample of 138 primary-care providers, nearly all physicians, associated with patients enrolled in eight cardiac-rehabilitation programs in Ontario. Of those, 71 (51.5%) received a discharge summary, the primary end point of the analysis; 64 of those also completed the survey.

According to their responses:

  • All providers actively wished to receive a summary, preferably by fax (61.3%), conventional mail (26%), or electronically (13%).
  • 89% reported that the summary was received in time for the patient’s first postrehab visit.
  • 77% of providers reported that the summary information would be used.

Medications, patient-care plan, and clinical status were rated by providers as the most important elements of the discharge summary. But that information was reported as missing in 19%, 4.7%, and 22% of cases, respectively.

As to why so many discharge summaries did not reach primary-care providers, it was found that many summaries were addressed to other persons at the primary-care provider’s location or were otherwise misdirected and that some patients failed to complete their assessments at the end of their rehabilitation program.

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12 thoughts on “Cardiac-rehab reports often don’t reach the primary-care doc

  1. thank you again — this is so critically misunderstood. i am actually having meetings w/ my care team: cardiologist, pcp, and personal trainer to make sure we are all on the same page and heading to the right goals.

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  4. One hardly knows where to start on the alarmingly long list of serious problems inherent in the cardiac rehabilitation system. First, we know that only a minority of heart patients are even referred to cardiac rehab in the first place. Men are twice as likely to be referred as women are. Only 20% of all patients entering structured rehabilitation programs are women. And women are 30% more likely to drop out of cardiac rehab even when they are referred by their doctors. Dr. Chris Blanchard at Dalhousie University has researched these disturbing findings – more at: http://myheartsisters.org/2009/12/30/women-only-cardiac-rehab/

    And then we have doctors saying ‘don’t bother sending me cardiac rehab reports because I won’t read them anyway!” The doctors surveyed in this York University study sound a tad more enlightened, although the miscommunication noted (addressed to the wrong person? missing key information?) is disturbing.

    Sigh . . .

    • Yes Carolyn, much to be fixed. Thus the effort to empower the patients. Educate all to the issues, be an active consumer, demand communication and reporting, get copies and review your records. Thanks again for reading and sharing. Keep up the good work!

  5. Add to this that the cardiac rehab I attend is understaffed, doesn’t follow procedures… I think they’d faint if someone came in who has trouble complying with the demands of the machines – and people do come with physical restrictions that are ignored. I can’t yet figure out who to contact to do a review of the program I am in who would actually do a program review and take corrective measure. I’m going to have to quit because I can’t tolerate the glaring and dangerous problems. Although, I have to say I’m almost more ticked off at fellow rehabers who never object to anything…never question… Maybe that’s the causal agent for the cardiac problems — the extremes; me-growing rabid about the gross deficiencies; and others – compliant as doormats.

    • PS I’d bet a bundle that if professional physical therapists and trainers came to one of these sessions incognito, they wouldn’t believe what goes on – or rather, does not.

    • Wow how sad, unfortunately that doesn’t surprise me. Many Cardiac Rehabilitation programs are run only with nurses, who are very smart but often lack the exercise science and exercise physiology background. A good program is multidisciplinary involving a very well rounded staff including those who specialize in exercise form and techniques. Some of the problem may be in the design of the class with too many patients to staff ratios to safely supervise and guide all participants. Writing a letter to the program manager and the hospital administration would probably be helpful so the program can identify the issue and begin to resolve the problems you have identified. It takes the squeaky wheel to make changes, and many are afraid to squeek.

  6. Thank you @rehabilitateyourheart for highlighting me and my colleagues research!! I really enjoyed your article and I hope patients’ and physicians’ do take your advice on patient empowerment. I presented the results of this research to all 8 participating Cardiac Rehabilitation (CR) sites in Ontario and they have made GP identification a priority in addition to other changes in their communication practices (e.g. transmission method). Too often, the referring physician’s name is left on the cover sheet (e.g. the cardiologist), so the discharge summary is not sent to the GP. Hopefully our study will help shape the production of standardized CR discharge summaries (with key information) and communication processes across all sites. Again, thank you.

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