Association of Discharge Summary Quality With Readmission Risk for Patients Hospitalized With Heart Failure Exacerbation

Al‐Damluji, Mohammed Salim; Dzara, Kristina; Hodshon, Beth; Punnanithinont, Natdanai; Krumholz, Harlan M.; Chaudhry, Sarwat I.; Horwitz, Leora I.

doi:10.1161/circoutcomes.114.001476

Cited by 52 publications

(73 citation statements)

References 10 publications

(11 reference statements)

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“…19 Focusing on the posthospital care transition, complete and available summaries have been shown to reduce hospital readmission risk. 10 Despite this recognition, our survey demonstrates that PCPs continue to identify deficits in HDS content and availability; although having access to inpatient medical data increases the likelihood that a clinician will have the HDS available to them, a high level of deficiency in desired content remains. In this age of practice redesign and electronic medical record deployment, our findings suggest that initial efforts should include ensuring availability of a complete summary (containing items deemed important by PCPs including diagnosis list, treatment provided, and medication list) at the posthospital follow-up visit.…”

Section: Discussionmentioning

confidence: 93%

“…4 Receipt of a summary by the PCP before the posthospital follow-up visit, as well as inclusion of salient content in the summary, may reduce the risk of adverse events such as hospital readmissions. 9,10 Some study of the interface between hospitalist and PCP has already taken place, confirming the importance of the HDS in this care transition. [11][12][13] To further quantify specific deficits in HDS content and delivery we designed a survey of primary care physicians in the United States.…”

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confidence: 80%

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Information Transfer and the Hospital Discharge Summary: National Primary Care Provider Perspectives of Challenges and Opportunities

et al. 2017

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Purpose:The hospital discharge summary (HDS) serves as a critical method of patient information transfer between hospitalist and primary care provider (PCP). This study was designed to increase our understanding of PCP preferences for, and perceived deficiencies in, the discharge summary.Methods: We designed a mail survey that was sent to a random sample of 800 American Academy of Family Physicians members nationally. The survey response rate was 59%. We analyzed the availability of summaries at hospital followup, whether all desired information was contained in the summary and whether certain specific items were completed. Provider subgroup analysis was performed.Results: The strongest predictor of discharge summary availability at posthospital followup is direct access to inpatient data. Respondents (27.5%) had a summary available 0% to 40% of the time, 41.4% noted availability 41% to 80% of the time and 31.1% >80% of the time; if a provider had access to inpatient data they tended to have a discharge summary available to them (P < .0001). Providers also described significant content deficits: 26.5% of providers noted the summary contained all information needed 0% to 40% of the time, 48.5% of providers noted this 41% to 80% of the time and only 25% >80% of the time. Specific summary items considered "very important" by providers included medication list (94% of respondents), diagnosis list (89%), and treatment provided (87%).

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Section: Discussionmentioning

confidence: 93%

mentioning

confidence: 80%

Information Transfer and the Hospital Discharge Summary: National Primary Care Provider Perspectives of Challenges and Opportunities

et al. 2017

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“…39 Higher quality discharge summaries and timely transmission are associated with a lower risk of readmission for HF patients. 40 Reducing medical errors and improving communication during transitions in care require continued attention.…”

Section: Health System Strategies To Reduce Readmissionsmentioning

confidence: 99%

The Prevention of Hospital Readmissions in Heart Failure

Ziaeian

Fonarow

2016

Progress in Cardiovascular Diseases

202

132

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Heart failure (HF) is a growing healthcare burden and one of the leading causes of hospitalizations and readmission. Preventing readmissions for HF patients is an increasing priority for clinicians, researchers, and various stakeholders. The following review will discuss the interventions found to reduce readmissions for patients and improve hospital performance on the 30-day readmission process measure. While evidence-based therapies for HF management have proliferated, the consistent implementation of these therapies and development of new strategies to more effectively prevent readmissions remain areas for continued improvement.

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“…Though there are several negative studies, 6–9 we have recently found that high quality discharge summaries may be associated with lower risk of readmission. 10 …”

mentioning

confidence: 99%

Hospital Variation in Quality of Discharge Summaries for Patients Hospitalized With Heart Failure Exacerbation

Al‐Damluji

Dzara

Hodshon

et al. 2015

Circ: Cardiovascular Quality and Outcomes

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Background Single-site studies have demonstrated inadequate quality of discharge summaries in timeliness, transmission and content, potentially contributing to adverse outcomes. However, degree of hospital-level variation in discharge summary quality for patients hospitalized with heart failure (HF) is uncertain. Methods and Results We analyzed discharge summaries of patients enrolled in the Telemonitoring to Improve Heart Failure Outcomes (Tele-HF) study. We assessed hospital-level performance on timeliness (fraction of summaries completed on the day of discharge), documented transmission to the follow-up physician, and content (presence of components suggested by the Transitions of Care Consensus Conference (TOCCC)). We obtained 1,501 discharge summaries from 1,640 (91.5%) patients discharged alive from 46 hospitals. Among hospitals contributing 10 or more summaries, the median hospital dictated 69.2% of discharge summaries on the day of discharge (range: 0.0–98.0%, p<0.001); documented transmission of 33.3% of summaries to the follow-up physician (range: 0.0–75.7%, p<0.001); and included 3.6/7 TOCCC elements (range: 2.9–4.5, p<0.001). Hospital course was typically included (97.2%), but summaries were less likely to include discharge condition (30.7%), discharge volume status (16.0%) or discharge weight (15.7%). No discharge summary included all seven TOCCC-endorsed content elements, was dictated on the day of discharge, and was sent to a follow-up physician. Conclusions Even at the highest performing hospital, discharge summary quality is insufficient in terms of timeliness, transmission and content. Improvements in all aspects of discharge summary quality are necessary to enable the discharge summary to serve as an effective transitional care tool.

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Association of Discharge Summary Quality With Readmission Risk for Patients Hospitalized With Heart Failure Exacerbation

Cited by 52 publications

References 10 publications

Information Transfer and the Hospital Discharge Summary: National Primary Care Provider Perspectives of Challenges and Opportunities

Information Transfer and the Hospital Discharge Summary: National Primary Care Provider Perspectives of Challenges and Opportunities

The Prevention of Hospital Readmissions in Heart Failure

Hospital Variation in Quality of Discharge Summaries for Patients Hospitalized With Heart Failure Exacerbation

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