ABSTRACT
BACKGROUND
Discharge summaries play a pivotal role in the transitional care of patients discharged to sub-acute care facilities, but the best ways to facilitate document completeness/quality remain unknown.
OBJECTIVE
To examine the relationship among clinical-work processes, provider characteristics, and discharge summary content to identify approaches that promote high-quality discharge documentation.
DESIGN
Retrospective cohort study.
SUBJECTS
All hip fracture and stroke patients discharged to sub-acute care facilities during 2003–2005 from a large Midwestern academic medical center (N = 489). Patients on hospice/comfort care were excluded.
MAIN MEASURES
We abstracted 32 expert-recommended components in four categories (‘patient’s medical course,’ ‘functional/cognitive ability at discharge,’ ‘future plan of care,’ and ‘name/contact information’) from the discharge summaries of sample patients. We examined predictors for the number of included components within each category using Poisson regression models. Predictors included work processes (document completion in relation to discharge day; completion time of day) and provider characteristics (training year; specialty).
KEY RESULTS
Historical components (i.e., ‘patient’s medical course’ category) were included more often than components that directly inform the admission orders in the sub-acute care facility (i.e., ‘future plan of care’). In this latter category, most summaries included a discharge medication list (99%), disposition (90%), and instructions for follow-up (91%), but less frequently included diet (68%), activity instructions (58%), therapy orders (56%), prognosis/diagnosis communication to patient/family (15%), code status (7%), and pending studies (6%). ‘Future plan of care’ components were more likely to be omitted if a discharge summary was created >24 h after discharge (incident rate ratio = 0.91, 95% confidence interval = 0.84–0.98) or if an intern created the summary (0.90, 0.83–0.97).
CONCLUSION
Critical component omissions in discharge summaries were common, and were associated with delayed document creation and less experienced providers. More research is needed to understand the impact of discharge documentation quality on patient/system outcomes.
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Contributors
The authors would like to acknowledge Peggy Munson for IRB assistance, Marissa Falk for data abstraction, Wen-Jan Tuan for data management, and Andrea Gilmore, Colleen Brown, and Melissa Hovanes for manuscript formatting.
Funders
This project was supported by a National Institute on Aging Beeson Career Development Award (K23AG034551, National Institute on Aging, The American Federation for Aging Research, The John A. Hartford Foundation, The Atlantic Philanthropies, and The Starr Foundation) and by a K-L2 through the National Institute of Health grant 1KL2RR025012-01 [Institutional Clinical and Translational Science Award (UW-Madison) 1UL1RR025011 (KL2) program of the National Center for Research Resources, National Institute of Health]. Additional support was provided by the University of Wisconsin (UW) Hartford Center of Excellence in Geriatrics, the UW School of Medicine and Public Health from The Wisconsin Partnership Program, the Health Innovation Program, the UW Hospitals and Clinics, and the Community-Academic Partnerships core of the University of Wisconsin Institute for Clinical and Translational Research (UW ICTR), grant 1UL1RR025011 from the Clinical and Translational Science Award (CTSA) program of the National Center for Research Resources, National Institutes of Health. The Health Innovation Program assisted with data management and with manuscript formatting. No other funding source had a role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; or preparation, review, or approval of the manuscript.
Prior Presentations
This paper has been presented at the Presidential Poster Session at the 2011 American Geriatrics Society Meeting, May 11–14, 2011, in Washington, D.C. This paper has not been presented or submitted for presentation at any other meetings.
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None disclosed.
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Kind, A.J., Thorpe, C.T., Sattin, J.A. et al. Provider Characteristics, Clinical-Work Processes and Their Relationship to Discharge Summary Quality for Sub-Acute Care Patients. J GEN INTERN MED 27, 78–84 (2012). https://doi.org/10.1007/s11606-011-1860-0
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DOI: https://doi.org/10.1007/s11606-011-1860-0