Rerun: Just how bad are hospital discharge summaries?

I’m taking a break from blogging this week so am rerunning some favorite posts from 2010. Please visit the original post to comment.

The hospital discharge process is a rocky one. Such “transitions of care” are fraught with challenges as patients move from a highly supervised to less supervised settings, caregivers change, and information about the patient and their needs is transmitted. These hand-off’s are tough and the ball often gets dropped. Not infrequently the patient ends up right back in the hospital in a preventable readmission.

Discharge isn’t a neat, tidy process. For example, patients typically have test results pending when they leave the hospital. But what happens to those results? According to a study in the Journal of General Internal Medicine reported in Today’s Hospitalist (Pending test results go AWOL), the pending tests are not being reported on hospital discharge summaries:

  • All patients in the study had tests pending at discharge, but only a quarter mentioned that any tests were pending
  • Only 13 percent said what those tests were

The study’s author, Dr. Martin Were, was “shocked” by the results:

“We already know that outpatient providers aren’t very good at following up on pending tests documented in the discharge summary,” Dr. Were says. “Imagine how much worse the follow-up is when pending tests aren’t even documented.”

And while information technology might help manage pending test results, Dr. Were says that’s only half the battle. There are no accepted standards for who should receive those results and who is responsible for following up on them…

“I expected discharge summaries to be inadequate, but I didn’t expect them to be that inadequate”

…And it’s a problem… that’s being exacerbated by the growth of hospital medicine for two reasons: More and more patients are seen by separate inpatient and outpatient physicians, and sicker patients are being discharged soon from hospitals.

There’s a major quality and patient safety opportunity here and I expect the gaps to be closed over time. In the meantime I wonder how much performance varies between best in class hospitals and others.

This should also be a wake-up call for patients and families. Although there’s not that much a patient can do to change what happens in the hospital or at discharge, I’d suggest finding a good primary care physician who’s tightly integrated into a hospital system that uses good information technology. That way the physician knows you, and has access to your medical record including lab tests performed in the hospital. I don’t think it’s necessary or even desirable to avoid hospitals that use hospitalists as long as you have the other pieces in place.

December 28, 2010