Comprehensive quality of discharge summaries at an academic medical center

Abstract

Background Discharge summaries are essential to safe transitions from hospital to home. Objective To conduct a comprehensive quality assessment of discharge summaries. Design Prospective cohort study. Subjects 377 patients discharged home after hospitalization for acute coronary syndrome, heart failure or pneumonia. Measures Discharge summaries were assessed for timeliness of dictation, transmission of the summary to appropriate outpatient clinicians and presence of key content, including elements required by The Joint Commission and elements endorsed by six medical societies in the Transitions of Care Consensus Conference (TOCCC). Results A total of 376 of 377 patients had completed discharge summaries. A total of 174 (46.3%) summaries were dictated on the day of discharge; 93 (24.7%) were completed more than a week after discharge. A total of 144 (38.3%) discharge summaries were not sent to any outpatient physician. On average, summaries included 5.6 of 6 Joint Commission elements and 4.0 of 7 TOCCC elements. Summaries dictated by hospitalists were more likely to be timely and to include key content than summaries dictated by house staff or advanced practice nurses. Summaries dictated on the day of discharge were more likely to be sent to outside physicians and to include key content. No summary met all three quality criteria of timeliness, transmission and content. Conclusions Discharge summary quality is inadequate in many domains. This may explain why individual aspects of summary quality such as timeliness or content have not been associated with improved patient outcomes. However, improving discharge summary timeliness may also improve content and transmission.

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

“…4,9,16 -18 Previous studies have shown that many physician trainees feel unprepared to write discharge summaries 13 , and that academic medical centers may trail other practice settings in the timely provision of complete summaries. 1,16 The relatively small number of responses within the academic practice subgroup (n ϭ 40) limits our ability to draw strong conclusions; however, the finding that PCPs in academic settings tend to be slightly less likely to have the HDS available at posthospital followup (when adjusted for direct access to inpatient data) offers some validation that this issue lingers. Although our survey did not address potential causative factors, differential utilization of electronic medical records in academic centers, conflicting priorities for learners and teachers (ie, not viewing documentation preparation as a learning experience) and time pressure (resulting from duty hour limitations and other educational commitments) may contribute to this result.…”

Optimizing the quality of hospital discharge summaries – a systematic review and practical tools

“…However, there are no such reviews on DS. A timely DS seems to be associated with a reduction in hospital readmission as an indirect marker of patients' health outcome [64,73]. Improving the quality of DS helps to avoid errors and increase the quality of care, which is especially important with regard to medication errors [23].…”

Strategies to Reduce 30-Day Readmissions in Older Patients Hospitalized with Heart Failure and Acute Myocardial Infarction

“…Moreover, large numbers of minority-serving and safety-net hospitals have low rates of rehospitalization [5, 23]. Controversy also exists within the epidemiologic literature as to whether specific discharge and transitional care practices such as patient discharge education [24], early outpatient follow-up [25-27], and improved communication between hospital and outpatient provider [28, 29] are associated with lower readmission, possibly because the quality of education, communication, and follow-up visits have been difficult to model [30]. Isolated studies have shown that higher readmission rates are associated with lower hospital case volume, lack of availability of advanced cardiac services, and lower nurse-to-patient ratios [31, 32].…”