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

Abstract

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.

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

“…This problem is not limited to local or situational circumstances. As the study by Al-Damluji et al noted, the low quality of DS seems to be independent of the performance level, teaching status, and geographical and other characteristics of hospitals [12].…”

“…Only few studies address the patients' outcome as endpoints [12,64]. The studies on medication errors in DS were not the focus of this review.…”

“…A group of leading US medical societies has developed standards for transition documents (Transition of Care Consensus Conference [TOCCC]) [12,18]. These standards include content standards in which the minimum requirements consist of a diagnosis and problem list, medication list, identification and contact information of the coordinating physician, patient's cognitive status, and a list of results.…”

“…Despite this effort, DS often have considerable shortcomings regarding their completeness and quality [6,7], which is especially true for the prescription of medications [8]. Studies have consistently shown that, at most, only 70% of the DS meet the requirements established in the guidelines, and up to 40% are incorrect in some way [9][10][11][12][13].…”

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

“…8 We defined timeliness as days between discharge date and preparation date. 9 We defined transmission as any notation that the summary was sent to any of the clinicians listed as having a follow up appointment with the patient.…”