Patient Safety Concerns Arising from Test Results That Return after Hospital Discharge

Roy, Christopher L.; Poon, Eric G.; Karson, Andrew S.; Ladak-Merchant, Zahra; Johnson, Robin E.; Maviglia, Saverio M.; Gandhi, Tejal K.

doi:10.7326/0003-4819-143-2-200507190-00011

Cited by 334 publications

(278 citation statements)

References 13 publications

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“…21 Poor discharge summary documentation of actionable components, such as diet and therapy orders, has the potential to directly impact the patient's plan of care/ admission orders within the sub-acute care facility and may increase the risk for rehospitalization, excess sub-acute care nursing and therapy staff work load, and other negative posthospital outcomes. [22][23][24] This poor documentation may reflect a lack of appreciation for the needs of the sub-acute care patient and multi-disciplinary care team, the need for a standardized approach to discharge documentation, and the absence of regulation and assessment to ensure discharge documentation quality. 1,6,16 Additional research is needed to better understand the connection between discharge documentation quality and patient/system outcomes.…”

Section: Discussionmentioning

confidence: 99%

Provider Characteristics, Clinical-Work Processes and Their Relationship to Discharge Summary Quality for Sub-Acute Care Patients

et al. 2011

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Section: Discussionmentioning

confidence: 99%

Provider Characteristics, Clinical-Work Processes and Their Relationship to Discharge Summary Quality for Sub-Acute Care Patients

et al. 2011

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“…Kripalani et al 5 noted the substantial deficits in communication between providers at times of discharge. 5 Discontinuity in the transition from inpatient to outpatient care has been shown to lead to medical errors and patient safety concerns, ranging from lab and radiology results pending on hospital discharge 36 to adverse drug reactions 37 to readmissions. 10 Moreover, Hesselink et al, 38 in their review of patient handovers from hospital back to primary care, concluded that multicomponent interventions were most effective.…”

Section: Discussionmentioning

confidence: 99%

Provider-to-Provider Communication during Transitions of Care from Outpatient to Acute Care: A Systematic Review

et al. 2015

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BACKGROUND: Most research on transitions of care has focused on the transition from acute to outpatient care. Little is known about the transition from outpatient to acute care. We conducted a systematic review of the literature on the transition from outpatient to acute care, focusing on provider-to-provider communication and its impact on quality of care. METHODS: We searched the MEDLINE, CINAHL, Scopus, EMBASE, and Cochrane databases for English-language articles describing direct communication between outpatient providers and acute care providers around patients presenting to the emergency department or admitted to the hospital. We conducted double, independent review of titles, abstracts, and full text articles. Conflicts were resolved by consensus. Included articles were abstracted using standardized forms. We maintained search results via Refworks (ProQuest, Bethesda, MD). Risk of bias was assessed using a modified version of the Downs' and Black's tool. RESULTS: Of 4009 citations, twenty articles evaluated direct provider-to-provider communication around the outpatient to acute care transition. Most studies were cross-sectional (65 %), conducted in the US (55 %), and studied communication between primary care and inpatient providers (62 %). Of three studies reporting on the association between communication and 30-day readmissions, none found a significant association; of these studies, only one reported a measure of association (adjusted OR for communication vs. no communication, 1.08; 95 % CI 0.92-1.26). DISCUSSION: The literature on provider-to-provider communication at the transition from outpatient to acute care is sparse and heterogeneous. Given the known importance of communication for other transitions of care, future studies are needed on provider-to-provider communication during this transition. Studies evaluating ideal methods for communication to reduce medical errors, utilization, and optimize patient satisfaction at this transition are especially needed.KEY WORDS: care transitions; continuity of care; provider-to-provider communication.

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“…First, we utilized a single question derived from prior work in this area to assess the perceived duration of post-discharge responsibility (BHow many days are inpatient providers responsible for their patients after they are discharged?^). 5 To further explore the content of responsibility, we developed specific questions to assess residents' perceived responsibility within four key domains in transitions of care: (1) medication reconciliation, 12 (2) lab follow-up, 13,14 (3) postdischarge follow-up appointments, 15,16 and (4) communication with outpatient providers 17 . Within each of these domains, one question was developed to assess residents' perceived responsibility for discharge practices currently considered the standard of care based on consensus policy statements from multiple large professional societies 7,18 (e.g., BAs an inpatient provider, I am responsible for ensuring that labs pending at the time discharge are accurately documented in my discharge summary^).…”

Section: Survey Instrumentmentioning

confidence: 99%

Internal Medicine Residents’ Perceived Responsibility for Patients at Hospital Discharge: A National Survey

et al. 2016

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BACKGROUND: Medical residents are routinely entrusted with transitions of care, yet little is known about the duration or content of their perceived responsibility for patients they discharge from the hospital. OBJECTIVE: To examine the duration and content of internal medicine residents' perceived responsibility for patients they discharge from the hospital. The secondary objective was to determine whether specific individual experiences and characteristics correlate with perceived responsibility. DESIGN: Multi-site, cross-sectional 24-question survey delivered via email or paper-based form. PARTICIPANTS: Internal medicine residents (post-graduate years 1-3) at nine university and community-based internal medicine training programs in the United States. MAIN MEASURES: Perceived responsibility for patients after discharge as measured by a previously developed single-item tool for duration of responsibility and novel domain-specific questions assessing attitudes towards specific transition of care behaviors. KEY RESULTS: Of 817 residents surveyed, 469 responded (57.4 %). One quarter of residents (26.1 %) indicated that their responsibility for patients ended at discharge, while 19.3 % reported perceived responsibility extending beyond 2 weeks. Perceived duration of responsibility did not correlate with level of training (P = 0.57), program type (P = 0.28), career path (P = 0.12), or presence of burnout (P = 0.59). The majority of residents indicated they were responsible for six of eight transitional care tasks (85.1-99.3 % strongly agree or agree). Approximately half of residents (57 %) indicated that it was their responsibility to directly contact patients' primary care providers at discharge. and 21.6 % indicated that it was their responsibility to ensure that patients attended their follow-up appointments. CONCLUSIONS: Internal medicine residents demonstrate variability in perceived duration of responsibility for recently discharged patients. Neither the duration nor the content of residents' perceived responsibility was consistently associated with level of training, program type, career path, or burnout, suggesting there may be unmeasured factors such as professional role modeling that shape these perceptions.

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Patient Safety Concerns Arising from Test Results That Return after Hospital Discharge

Abstract: Many patients are discharged from hospitals with test results still pending, and physicians are often unaware of potentially actionable test results returning after discharge. Further work is needed to design better follow-up systems for test results returning after hospital discharge.

Cited by 334 publications

References 13 publications

Provider Characteristics, Clinical-Work Processes and Their Relationship to Discharge Summary Quality for Sub-Acute Care Patients

Provider Characteristics, Clinical-Work Processes and Their Relationship to Discharge Summary Quality for Sub-Acute Care Patients

Provider-to-Provider Communication during Transitions of Care from Outpatient to Acute Care: A Systematic Review

Internal Medicine Residents’ Perceived Responsibility for Patients at Hospital Discharge: A National Survey

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