YaleNews | When used effectively, discharge summaries reduce hospital readmissions.
For heart failure patients making the transition from hospital to home, a discharge summary that gets to their primary doctors quickly and contains detailed and useful information can mean the difference between recovering quickly or returning to the hospital, according to two new studies from Yale School of Medicine researchers.
The findings are published by the Yale research team in the current issue of Circulation: Cardiovascular Quality and Outcomes.
In theory, a discharge summary is meant to help outside physicians understand what happened to patients while they were hospitalized, but in practice, it has served as an aid for medical billing, according to lead author Dr. Leora Horwitz, adjunct associate professor of internal medicine at Yale School of Medicine and director of the Center for Healthcare Innovation and Delivery Science at New York University Langone Medical Center. “The medical community hasn’t really made full use of discharge summaries as a tool for transitions,” she said.
Horwitz and her team analyzed data from Telemonitoring to Improve Heart Failure Outcomes (Tele-HF), a large multicenter study of patients hospitalized with heart failure. This data contained more than 1,500 discharge summaries from 46 hospitals across the country. Horwitz said in order for a discharge summary to do the job of making the transition from hospital to home safer, it needs three key factors: It has to be timely, it has to be sent to the outside physician, and it has to include useful information. “It’s like a three-legged stool,” she said. “All three need to be present in order for it to do its job.”
In the first study, Horwitz and her team expected the summaries to be similar at all the hospitals they analyzed, but they found that hospitals varied widely in their performance. And even at the highest-performing hospitals, the quality of discharge summaries was insufficient in terms of timeliness, transmission, and content. No hospital consistently produced high-quality summaries in all domains.
In the second study using the same data from Tele-HF, the team looked at whether improving hospital practices regarding discharge summaries made a difference in hospital readmissions. They found that discharge summary quality was indeed associated with readmission risk; patients whose summaries included useful content or were sent to outside clinicians had lower readmission rates.
“This study tells us for the first time that it is actually worth spending the time and effort to improve discharge communication, and patients do seem to benefit,” said Horwitz.
Other authors on the two studies include first author Dr. Mohammed Salim Al-Damluji; Kristina Dzara; Beth Hodshon; Dr. Natdanai Punnanithinont; Dr. Harlan M. Krumholz; and Dr. Sarwat I. Chaudhry.
The studies were funded in part by the National Heart, Lung, and Blood Institute; The National Institute on Aging; the American Federation for Aging Research through the Paul B. Beeson Career Development Awards in Aging Research Program; and the Center for Cardiovascular Outcomes Research at Yale. Horwitz is also a recipient of the Clinical and Translational Science Award from Yale Center for Clinical Investigation.
Citations: Circ Cardiovasc Qual Outcomes
DOI: 10.1161/CIRCOUTCOMES.114.001227
DOI: 10.1161/CIRCOUTCOMES.114.001476
Discharge summaries are vital to insure effective transition to post acute care settings, regardless of whether the patient is discharged to a post acute care setting such as a skilled nursing facility, inpatient rehab facility or discharged home with or without home health. All too often, discharge summaries are nothing more than a literal cut and paste from the History and Physical with the addition of the final diagnoses and plan for further outpatient care. The results of this study highlight the real value of a complete, encompassing discharge summary that provides an accurate account of the patient’s hospitalizations including presenting signs and symptoms, acute and chronic clinical conditions managed during the stay, clear account of diagnostic workup, plans for further patient workup, continued care and outpatient workup including results of pending tests and primary care workup, any new and continuing meds, and any special instructions and cautions for the patient and family caregiver written in simple layman’s terms.
The Joint Commission and the National Quality Forum have developed mandated guidelines containing key elements of a discharge summary and the link below contains an excellent slide show on improving discharge summaries from an internal medicine perspective.
http://www.slideshare.net/emallin/improving-timeliness-and-quality-discharge-summaries-dictated-by-internal-medicine-residents
I will be blogging on the role of the CDIS in promoting complete and accurate discharge summaries in my next post. Stay tuned