Abstract 15569: Quality of Discharge Summaries in Patients Hospitalized With Heart Failure Exacerbation
Introduction: Several small studies demonstrate that the quality of discharge summaries is inadequate, potentially contributing to errors and adverse outcomes. However, these studies primarily involve large academic teaching institutions. The quality of discharge communication for patients with heart failure (HF) across the nation is uncertain.
Objective: To determine the timeliness, transmission and content of discharge summaries generated after admission for HF exacerbation.
Methods: We analyzed discharge summaries of patients enrolled in the Tele-HF study, a multisite randomized controlled trial of telemonitoring. We included any summary of patients admitted with heart failure who survived to discharge. We assessed timeliness (fraction of summaries completed on the day of discharge), documented transmission to the follow-up physician, and content. For content we examined the proportion of summaries that included components mandated by The Joint Commission and components suggested by the Transitions of Care Consensus Conference (TOCCC) (principal diagnosis, problem list, medication list, transferring physician name and contact, cognitive status, test results, pending tests).
Results: 1,501/1,640 (91.5%) discharge summaries from 46 hospitals met inclusion criteria. A total of 822 (55.4%) discharge summaries were dictated on discharge day; 208 (13.9%) were dictated more than ten days after discharge. Transmission of the summary to the follow-up physician was documented in 464 (32.1%) summaries. Hospital course was universally included (97.2%), but summaries were less likely to include any comment about discharge status (30.7%), discharge weight (15.7%) or pending studies (1.7%). Discharge summaries included a mean of 3.9/5 Joint Commission elements and mean of 2.8/7 TOCCC elements. No discharge summary fulfilled all three criteria of timeliness, transmission and comprehensive content.
Discussion: Discharge summary quality is insufficient in terms of timeliness, transmission and content. Content is focused on inpatient information rather than discharge day information. If the discharge summary is to serve as an effective transitional care tool, improvements in all aspects of discharge summary quality will be necessary.
- © 2013 by American Heart Association, Inc.