Dr. Krumholz chairs a cardiac scientific advisory board for UnitedHealth. He sees unstable patients as early as the day after discharge and said, “It primary care physician. A structured, standard discharge summary form ensures that all the important information Dr. Krumholz chairs a cardiac scientific advisory board for UnitedHealth. of 73 studies, the primary diagnosis was omitted a median of 17.5% of the time, a “We're still a long way off from having a perfect discharge summary.”. Each discharge summary was sent to a median of 1 physician besides the dictating physician (IQR: 01). Dr. Krumholz receives support from the Centers of Medicare and Medicaid Services (CMS) to develop and maintain performance measures that are used for public reporting, including readmission measures. [6] Deficits such as these persist despite the fact that the rate of postdischarge completion of recommended tests, referrals, or procedures is significantly increased when the recommendation is included in the discharge summary. We assessed differences in quality measures between APRNs, housestaff, and hospitalists using 2 tests. Nearly every discharge summary included information about admitting diagnosis, hospital course, and procedures or tests performed during the hospitalization. medicine division at Chicago's Northwestern Medical Center and co-author of the JAMA article. Discharge summaries were typically dictated by APRNs for cardiology patients, by 2nd‐ or 3rd‐year residents for housestaff patients, and by hospitalists for hospitalist patients. on what needs inclusion but because hospitalists are busy and may not have time to Summaries dictated on the day of discharge were more likely than delayed summaries to be sent to at least 1 outside physician (75.9% vs 49.5%, P<0.001). also frequently suffer in quality by being too long and containing unnecessary information, [1]More recent studies have shown little improvement. call to inform him of his patient's discharge. Dr. Yadav at Baystate—are helping their institutions develop templates for We performed a number of tests which revealed that your heart wasn’t pumping as effectively as it should have been. Every discharge summary received 1 point for attending physician signature, because all discharge summaries were electronically signed. In addition, hospitalists at our institution explicitly prioritize timely and comprehensive discharge dictations, because their business relies on maintaining good relationships with outpatient physicians who contract for their services. “Discharge is a critical time for the patient,” Dr. Bodenheimer said. [26] As with all automated or electronic applications, it will be essential to consider workflow, readability, and ability to synthesize information prior to adoption. improving.”. ensure timely transmission of the discharge summary. Summaries dictated by hospitalists were most likely to be sent to at least 1 outside physician (54.7% APRNs, 58.5% housestaff, 73.7% hospitalists, P=0.006). patient a copy of the discharge summary to hand-deliver to their physician. A discharge summary is a collection of information about events during care of a patient by a provider or organisation. It is noteworthy, however, that the average time to dictation in this study was much lower than that of other studies,[4, 14, 30, 31, 32] suggesting that practices at this institution are at least no worse and possibly better than elsewhere. Discharge summaries were assessed for timeliness of dictation, transmission of the summary to appropriate outpatient clinicians, and presence of key content including elements required by The Joint Commission and elements endorsed by 6 medical societies in the Transitions of Care Consensus Conference (TOCCC). However, improving discharge summary timeliness may also improve content and transmission. Additionally, housestaff received a lecture about discharge summaries at the start of their 2nd year. However, few summaries included information about the patient's condition at discharge. these patients, compared with when the summary did not arrive on time. 483.15 Admission, Transfer, and Discharge Rights Implementation Phases: All requirements implemented in Phase 1 (November 28, 2016) with exception of:New regulations and guidelines: 483.15(c)(1)(ii) Discharge while appeal is We conducted multivariable logistic regression analyses for timeliness and for transmission to any outside physician. for followup, and results of any tests or lab work pending at time of discharge, said Guidelines for 42 CFR 482.43, Discharge Planning Memorandum Summary • Discharge Planning Guidance Revised: SOM Hospital Appendix A has been revised to update the guidance for the discharge planning Condition of • Discharge has been formalised in writing with a discharge summary and follow up actions clearly indicated to relevant providers. Maximizing capabilities of electronic records may help; many content elements that were commonly missing (e.g., pending results, discharge vitals, discharge weight) could be automatically inserted from electronic records. Computerised updating of clinical summaries: new opportunities for clinical practice and research? and fail to reach the primary care physician in time for the patient's follow-up visit, provider in time for the follow-up visit, the study found. and primary care physician, but it isn’t always given the priority Discharge planning is the process by which the hospital team considers what support might be required by the patient in the community, refers the patient to these services, and then liaises with these services to manage the patient’s discharge. We proposed to implement the discharge planning requirements mandated in section 1899B(i) of the Act by modifying the discharge planning or discharge summary CoPs for hospitals, CAHs and HHAs. Kathleen Louden is a freelance health writer in Gurnee, Ill. Key elements of discharge summaries, according to the Society of Hospital Medicine, His hospital started using a template several years ago. We further examine the effect of provider training level and timeliness of dictation on discharge summary quality.METHODSStudy CohortThe DISCHARGE study was a prospective, observational cohort study of patients 65 years or older discharged to home from YaleNew Haven Hospital (YNHH) who were admitted with acute coronary syndrome (ACS), community‐acquired pneumonia, or heart failure (HF). For instance, previous studies have found that timely receipt of a discharge summary does not reduce readmission rates. The authors would like to acknowledge Amy Browning and the staff of the Center for Outcomes Research and Evaluation Follow‐Up Center for conducting patient interviews, Mark Abroms and Katherine Herman for patient recruitment and screening, and Peter Charpentier for Web site development. However, independent physicians [22] In our institution, a template exists, but it favors a hospitalization‐focused rather than transition‐focused approach to the discharge summary. We assessed differences in quality measures between APRNs, housestaff, and hospitalists using 2 tests. A total of 144 (38.3%) discharge summaries were not sent to any physician besides the inpatient attending, and 209/374 (55.9%) were not sent to at least 1 physician listed as having a follow‐up appointment planned with the patient. In this article we examine discharge summaries of patients enrolled in the study to determine the timeliness, transmission to outside physicians, and content of the summaries. The NQF, in its Safe Practice 11, recommends that a discharge summary include, at When We also measured compliance with The Joint Commission mandates and TOCCC recommendations, which included several of the individual content items.To measure compliance with The Joint Commission requirements, we created a composite score in which 1 point was provided for the presence of each of the 6 required elements (maximum score=6). Commission Poor discharge planning can lead to poor patient The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute on Aging, the National Center for Advancing Translational Sciences, the National Institutes of Health, The John A. Hartford Foundation, the National Heart, Lung, and Blood Institute, or the American Federation for Aging Research. Journal of Hospital Medicine 2013;8:436–443. discharge summaries and omission of important data occur not because physicians disagree [6] Deficits such as these persist despite the fact that the rate of postdischarge completion of recommended tests, referrals, or procedures is significantly increased when the recommendation is included in the discharge summary.[7]. The HHA discharge summary As stated above, the A discharge summary is based on a national standard for a patient's hospital visit.What is a discharge summary?The Agency's discharge summary specification supports a national standard for electronically capturing details of a patient's hospital stay in a structured format. The National guidelines for on-screen presentation of discharge summaries specify the sequence, layout and format of the core elements of hospital discharge summaries, as displayed in clinical information systems. On average, summaries included 5.6 of the 6 Joint Commission elements and 4.0 of the 7 TOCCC elements. Thus, designing templates specifically for transitional care is key. A total of 3743 patients over 64 years old were discharged home from the medical service at YNHH during the study period; 3028 patients were screened for eligibility within 24 hours of admission. Additional inclusion criteria included speaking English or Spanish, and ability of the patient or caregiver to participate in a telephone interview. No summary met all 3 quality criteria of timeliness, transmission, and content.CONCLUSIONSDischarge summary quality is inadequate in many domains. Copyright © by Society of Hospital Medicine or related companies. Fourth, we did not determine whether the information in discharge summaries was accurate or complete; we merely assessed whether it was present. Medians and interquartile ranges (IQRs) or counts and percentages were calculated for summary measures of timeliness, transmission, and content. For instance, previous studies have found that timely receipt of a discharge summary does not reduce readmission rates. 1, 2. A total of 144 (38.3%) discharge summaries were not sent to any outpatient physician. As a result… Ethics approval was obtained from the University of Wollongong’s Human Research Ethics Committee (reference HE13/471). This is often given to the patient at discharge or posted out to the patient’s home: 1. Some studies have found that templates improve discharge summary content. [13] Each content element is shown in (see Supporting Information, Appendix 2, in the online version of this article), which also indicates the elements included in the 2 guidelines. San Francisco, who has written about transitions in care, said that variability in Every discharge summary received 1 point for discharge medications, because these are automatically appended.We obtained data on age, race, gender, and length of stay from hospital administrative databases. Summaries dictated on the day of discharge were more likely than delayed summaries to be sent to at least 1 outside physician (75.9% vs 49.5%, P<0.001). © 2013 Society of Hospital Medicine. [1, 2, 3] In a 1960 study, only 30% of discharge letters were received by the primary care physician within 48 hours of discharge. However, for each summary, a median of 1 physician (IQR: 01) who had a scheduled follow‐up with the patient did not receive the summary. Rate of inclusion of each content element is shown in Table 3, overall and by training level. 2002;17:186-192), found a 0.74 relative risk of decreased rehospitalization for Some studies have found that templates improve discharge summary content. Experts recommend that community physicians have input into this Accordingly, proportional odds models were used, in which the reported odds ratios (ORs) can be interpreted as the average effect of the explanatory variable on the odds of having more recommendations, for any dichotomization of the outcome. Summaries dictated on the day of discharge were more likely to be sent to outside physicians and to include key content. Summaries dictated by hospitalists were more likely to be timely and to include key content than summaries dictated by housestaff or advanced practice nurses. Dr. Horwitz had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. We coded the TOCCC content outcome as a 3‐level variable indicating <4, 4, or >4 elements satisfied. First, as a single‐site study at an academic hospital, it may not be generalizable to other hospitals or other settings. Patients enrolled in hospice were excluded, as were patients who failed the Mini‐Cog mental status screen (3‐item recall and a clock draw)[21] while in the hospital or appeared confused or delirious during the telephone interview. discover infractions, “the reality is that penalization does not happen.”. Third, we had too few readmissions in the dataset to have enough power to determine whether discharge summary content, timeliness, or transmission predicts readmission. The Joint Commission mandates that discharge summaries contain certain components: Thomas Bodenheimer, FACP, an internist affiliated with the University of California, Iqr: 01 ) consider strategies for patients at increased risk of readmission,.. 1 ] more recent studies have found that templates improve discharge summary until,... Mean it serves a patient ’ s care plan to the patient ’ s home 1! 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Academic hospital, it may be that hospital culture treats hospitalizations as discrete and self‐contained events rather than components... Physician besides the dictating physician ( IQR: 01 ) goodness‐of‐fit statistics were used assess...

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