Assessment of requests for medication-related follow-up after hospital discharge, and the relation to unplanned hospital revisits, in older patients: a multicentre retrospective chart review

Abstract

Background The discharge of older hospitalised patients is critical in terms of patient safety. Inadequate transfer of information about medications to the next healthcare provider is a known problem, but there is a lack of understanding of this problem in settings where shared electronic health records are used. The aims of this study were to evaluate the prevalence of patients for whom hospitals sent adequate requests for medication-related follow-up at discharge, the proportion of patients with unplanned hospital revisits because of inadequate follow-up requests, and the association between medication reviews performed during hospitalisation and adequate or inadequate follow-up requests. Methods We conducted a retrospective chart review. The study population was randomly selected from a cluster-randomised crossover trial which included patients 65 years or older who had been admitted to three hospitals in Sweden with shared electronic health records between hospital and primary care. Each patient was assessed with respect to the adequacy of the request for follow-up. For patients where the hospitals sent inadequate requests, data about any unplanned hospital revisits were collected, and we assessed whether the inadequate requests had contributed to the revisits. The association between medication reviews and adequate or inadequate requests was analysed with a Chi-square test. Results A total of 699 patients were included. The patients’ mean age was 80 years; an average of 10 medications each were prescribed on hospital admission. The hospitals sent an adequate request for 418 (60%) patients. Thirty-eight patients (14%) had a hospital revisit within six months of discharge which was related to an inadequate request. The proportion of adequate or inadequate requests did not differ between patients who had received a medication review during hospitalisation and those who had not (p = 0.83). Conclusions The prevalence of patients for whom the hospitals sent adequate follow-up requests on discharge was low. More than one in every ten who had an inadequate request revisited hospital within six months of discharge for reasons related to the request. Medication reviews conducted during hospitalisation did not affect the proportion of adequate or inadequate requests sent. A communication gap still exists despite the usage of a shared electronic health record between primary and secondary care levels.

Hvordan kan digital dokumentation blive en vej til sammenhæng i borgerforløb?

“…Det ser dog ud til, at digital dokumentation er et tveaegget svaerd for patientsikkerheden (11). På den ene side kan den digitale dokumentation understøtte patientsikkerheden ved at reducere medicinfejl (12). På den anden side kan der ikke findes evidens for, at den digitale dokumentationsform forbedrer patientsikkerheden.…”

The complexities of communication at hospital discharge of older patients: a qualitative study of healthcare professionals’ views

“…Nearly all hospitalised older patients experience at least one medication change that continues after hospital discharge, where the mean number is 3-4 changes [20][21][22]. The timely transfer of the discharge summary with clear requests for follow-up is considered crucial for the next healthcare provider [23].…”

“…The GPs were especially exposed to the communication gap, as it was apparent that they had strong doubts about the correctness of the information and that it would be transferred to the receivers in a timely manner. The doubts are supported by the knowledge that discharge information transferred from hospitals is often deficient [21,22,25,58]. This is worrying, as impaired transfers of discharge information have been linked to patient safety risks [24].…”