Education And Debate

Continuity of hospital care: beyond the question of personal contact

BMJ 2002; 324 doi: http://dx.doi.org/10.1136/bmj.324.7328.36 (Published 05 January 2002) Cite this as: BMJ 2002;324:36
  1. Unni Krogstad, hospital researcher (ukrogstad@heltef.no)a,
  2. Dag Hofoss, senior researchera,
  3. Per Hjortdahl, professorb
  1. a HELTEF Foundation for Health Services Research, Central Hospital of Akershus, N-1474 Nordbyhagen, Norway
  2. b Department of General Practice and Community Medicine, University of Oslo, N-0316 Oslo, Norway
  1. Correspondence to: U Krogstad
  • Accepted 5 July 2001

Patients' experiences have placed continuity of hospital care on the agenda in Norway1 as in other countries. 2 3 Although continuity of care has a long history in the literature of primary care,49 the concept is not often related to hospital care. Most of such publications deal with long term hospitalisation,10 psychiatry,11 and nursing12 and focus on personal continuity—where one clinician is responsible for each patient. The reality of acute treatment and care in the hospital environment is ignored, and there is confusion over the concept of continuity of hospital care. 13 14

Box 1 : Personal continuity may cause system discontinuity18

“Every time I or another patient asked for help the answer was always the same, ‘somebody else is responsible for you.’ I'm sure that if staff had given the service asked for instead of looking for the ‘right person,’ both the patients and the hospital would have saved time and frustration.”

“I'm satisfied with doctors and nurses, but you have to be really alert to make sure the information you give is passed through to the responsible persons. You never know if you are talking to the person in charge of you or just another messenger.”

RETURN TO TEXT

Continuity of care is important for patients' satisfaction in primary and hospital care. 1 15 To compensate for the fragmented nature of specialised hospital care, many hospitals try to imitate primary care by designating one carer to a particular patient. This kind of personal continuity is important, but it does not ensure that patients receive the best treatment during their hospital stay. It is important to recognise that continuity of care when the carer is an institution differs in important aspects from continuity when the carer is a person.

We discuss continuity in relation to the fact that hospital care is an organised, multidisciplinary, …

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