Discharge summaries (DS) communicate important clinical information from inpatient to outpatient settings. Previous studies noted increased adverse events and rehospitalization due to poor DS quality. We postulated that an audit and feedback intervention of DS completed by geriatric medicine fellows would improve the completeness of their summaries. We conducted a preintervention post intervention study. In phase 1 (AUDIT #1 and FEEDBACK) we scored all DS (n ¼ 89) completed by first year fellows between July 2006 to December 2006 using a 21-item checklist. Individual performance scores were reviewed with each fellow in 30-minute feedback sessions. In phase 2 (AUDIT #2) we scored all DS (n ¼ 79) completed after the first phase between February 2007 to July 2007 using the same checklist. Data were analyzed using generalized estimating equations. Fellows were more likely to complete all required DS data after feedback when compared with prior to feedback (91% vs. 71%, P < 0.001). Feedback was also associated with improved admission (93% vs. 70%, P < 0.001), duration of hospitalization (93% vs 78%, P < 0.001), discharge planning (93% vs. 18%, P < 0.02) and postdischarge care (83% vs. 57%., P < 0.001) section-specific information. In conclusion, audit and feedback sessions were associated with better DS completeness in areas of particular importance to geriatric care.
ObjectivesRe-admissions after hospitalisation are a burden for patients and costly. Our objective was to examine whether re-admissions were increased among older patients when they or their surrogates disagreed with the discharge disposition recommended by the clinical team at hospital discharge.DesignRetrospective cohort study.SettingLarge academic medical centre in New York, NY.Participants514 hospital discharges of older patients admitted to a geriatric inpatient service between 1 July 2007 and 30 June 2008.Primary outcome measure and main independent variableRe-admissions for any reason to any hospital within 30 days after discharge were identified. Agreement or disagreement with the discharge disposition recommended by the clinical team at hospital discharge was assessed.ResultsAmong 514 hospital discharges of older patients, the mean age was 83.1 years (SD=8.3), 75.7% were women, and approximately 90% were living at home prior to hospitalisation, despite 47.1% having some degree of cognitive impairment and 56.4% requiring assistance for activities of daily living or independent activities of daily living. There were 42 (8.2%) disposition disagreements; the majority (n=25; 59.5%) were discharged home despite the clinical team's recommendation for discharge to an acute or subacute facility. Overall, 158 (30.7%) were re-admitted within 30 days. There was no difference in re-admission rates between discharges with and without disposition disagreements (33.3% (144 of 472) vs 30.5% (14 of 42), respectively; OR=1.14, 95% CI 0.57 to 2.19; p=0.71). Adjusted analyses were consistent with these findings.ConclusionsDischarge disposition disagreements occurred relatively infrequently after hospitalisation among a group of older patients managed by a geriatrics inpatient service. In addition, we found no differences in re-admission when comparing patients who agreed or disagreed with the clinical team's recommended discharge disposition.
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