Elderly at risk in care transitions When discharge summaries are poorly transferred and used –a descriptive study

Abstract

BackgroundDischarge summary with medication report effectively counteracts drug-related problems among elderly patients due to insufficient information transfer in care transitions. However, this requires optimal transfer and use of the discharge summaries. This study aimed to examine information transfer with discharge summaries from hospital to primary care.MethodsA descriptive study with data consisting of discharge summaries of 115 patients, 75 years or older, using five or more drugs, collected during one week from 28 different hospital wards in Skåne county, Sweden. Two weeks after discharge, information transfer was examined via review of primary care medical records. It was noted whether the discharge summary was received (i.e. scanned to the primary care medical records), if the medication list was updated with drug changes and if a patient chart entry regarding medication or its follow-up was made in the primary care medical records. An electronic survey, which was sent to 151 primary care units in Skåne county, was used to examine experiences of the information transfer.ResultsOut of 115 discharge summaries, 47 (41%) were found in the primary care medical records. Patient chart entries regarding medication or its follow-up were seen in 53 (46%) cases. Drug changes during hospitalisation were seen in 51 out of 76 patients without multidose drug dispensing. In 16 (31%) out of these cases, medication lists were updated in primary care medical records.In the electronic survey, 22 (21%) out of the 107 responding primary care units reported the discharge summary was often received on the day of discharge, while 71 (66%) respondents indicated the discharge summary was always/often received but later. Medication list updates and patient chart entries in the primary care medical records were always/often done upon receipt of the discharge summary according to 61 (57%) respondents.ConclusionThe transfer of information was often deficient and the discharge summaries were insufficiently used. Many discharge summaries were lost, an insufficient proportion of medication lists were updated and patient chart entries were often lacking. These findings may increase the risk of medication errors and drug-related problems for elderly in care transitions.

Risk factors for hospital readmission in older adults within 30 days of discharge – a comparative retrospective study

“…Neither can we be certain that the non-significant difference between groups in regard to transfer of information to the primary care centre is correct and there is no way of telling if the patient actually received or took part of the contents of their discharge summary or not. Previous studies do, however, show that discharge summaries are often lacking in content and quality [49,50] as is the transfer of these to the next caregiver [50]. Even though the discharge summary, medication report and medications list are considered to be helpful to the GPs, their use of the information provided is often lacking due to the uneven quality as well as the discrepancies found in the medications lists included [49][50][51].…”

“…Previous studies do, however, show that discharge summaries are often lacking in content and quality [49,50] as is the transfer of these to the next caregiver [50]. Even though the discharge summary, medication report and medications list are considered to be helpful to the GPs, their use of the information provided is often lacking due to the uneven quality as well as the discrepancies found in the medications lists included [49][50][51]. These deficits lead to risks of medication errors and ADEs for older patients in transitions of care [49,52] and could be part of the reason as to why older adults living in the community with home care have increased odds of readmission as compared to those living in nursing homes.…”

Impact of the COVID-19 pandemic on acute surgical patients’ discharge summaries – Experience of Wales worst-hit COVID-19 hospital

“…11,14 Several studies have also identified that delays in submission of discharge summaries have caused significant consequences such as an increased rate of readmission 7 and inappropriate restarting of medications, resulting in readmission and risk of medication errors. 15,16…”

Is failure to act on discharge summaries causing harm in general practice?

“…A small study in Sweden highlighted the risk of medication errors and drug-related problems for older people at discharge 2. It found that the discharge summaries were insufficiently used and that medication lists were not updated.…”