Sending thorough and timely discharge summaries to nursing homes when a patient is discharged from the hospital can help promote patient safety during the early days after a hospitalization.
The problem: These reports are frequently incomplete and delayed, according to researchers at the University of Wisconsin School of Medicine and Public Health. In a study that appeared this year in the Journal of General Internal Medicine, they found that discharge summaries regularly lacked necessary information on diet, activity level, therapy and pending laboratory tests of nursing home patients after departure from the hospital.
The study involved 489 Medicare patients treated for strokes and hip fractures. All were sent to nursing homes after discharge from the hospital between 2003 and 2005.
According to a requirement from The Joint Commission, hospitals must submit discharge summaries within 30 days after a patient leaves the hospital. Discharge summaries often serve as the primary template for guiding the care of patients discharged to nursing homes, especially in the first few days.
However, Amy Kind, MD, assistant professor of medicine in the division of geriatrics and lead author of the study, identified a number of problems with the summaries. They were often completed many days after the patient had already been discharged to the nursing home, some more than 30 days afterward.
In addition, as the time grew longer, the quality of the information within the summaries became poorer or more incomplete. This problem forces nursing home caregivers to spend valuable time contacting the hospital to determine how to proceed with patient treatment.
"Right now, The Joint Commission standard for the creation of discharge summaries within 30 days is outdated because this standard doesn't optimally support patients who need care right after discharge," Kind said. "Our study is the first to suggest that the quality of the actual document starts getting worse the longer you wait to create a discharge summary. Important items are omitted, and because of that, patient care may suffer."
Kind said nearly a third of discharge summaries did not include information on the patient's dietary needs.
"If a patient had a stroke and has trouble swallowing, they may have been put on a specialized diet in the hospital," Kind said. "If that information is not communicated to the nursing home in the discharge summary and the patient does not receive their specialized diet, it is possible the patient may choke or contract pneumonia. There could be important consequences."
Kind added that instructions on therapy and activity needs were excluded on more than 40% of discharge summaries, and less than 10% included information on pending studies and laboratory tests.
"It makes a lot of sense to have a discharge summary completed on the day of discharge," she said. "It's pretty straightforward. They are an essential part of communication during the transitional care period."
Kind noted that one in five Medicare patients is rehospitalized within 30 days of discharge. Reports also indicate 2 million nursing home patients require rehospitalization annually at a cost of $17 billion to the Medicare system.
"Our study did not specifically look at the impact of discharge summary quality on patient rehospitalization, but our future work will," she said.
According to Kind, the Rehospitalization Reduction Act, part of the healthcare reform legislation approved by Congress in 2010, may be a positive step in getting hospitals to provide patient healthcare information to nursing homes more quickly and reliably.
The act would penalize hospitals if their rehospitalization rates for patients with heart failure, myocardial infarction and pneumonia are above a certain level, starting in 2013.
"The writers of the law said it is not acceptable for Medicare to pay for rehospitalization for one out of five patients," Kind said. "If we can provide better care, hopefully, we can make the patients happier and save money for the system."
To read the study, which was funded by the UW Health Innovation Program and the National Institutes of Health, visit http://bit.ly/sLV5VP.
The problem: These reports are frequently incomplete and delayed, according to researchers at the University of Wisconsin School of Medicine and Public Health. In a study that appeared this year in the Journal of General Internal Medicine, they found that discharge summaries regularly lacked necessary information on diet, activity level, therapy and pending laboratory tests of nursing home patients after departure from the hospital.
The study involved 489 Medicare patients treated for strokes and hip fractures. All were sent to nursing homes after discharge from the hospital between 2003 and 2005.
According to a requirement from The Joint Commission, hospitals must submit discharge summaries within 30 days after a patient leaves the hospital. Discharge summaries often serve as the primary template for guiding the care of patients discharged to nursing homes, especially in the first few days.
However, Amy Kind, MD, assistant professor of medicine in the division of geriatrics and lead author of the study, identified a number of problems with the summaries. They were often completed many days after the patient had already been discharged to the nursing home, some more than 30 days afterward.
In addition, as the time grew longer, the quality of the information within the summaries became poorer or more incomplete. This problem forces nursing home caregivers to spend valuable time contacting the hospital to determine how to proceed with patient treatment.
"Right now, The Joint Commission standard for the creation of discharge summaries within 30 days is outdated because this standard doesn't optimally support patients who need care right after discharge," Kind said. "Our study is the first to suggest that the quality of the actual document starts getting worse the longer you wait to create a discharge summary. Important items are omitted, and because of that, patient care may suffer."
Kind said nearly a third of discharge summaries did not include information on the patient's dietary needs.
"If a patient had a stroke and has trouble swallowing, they may have been put on a specialized diet in the hospital," Kind said. "If that information is not communicated to the nursing home in the discharge summary and the patient does not receive their specialized diet, it is possible the patient may choke or contract pneumonia. There could be important consequences."
Kind added that instructions on therapy and activity needs were excluded on more than 40% of discharge summaries, and less than 10% included information on pending studies and laboratory tests.
"It makes a lot of sense to have a discharge summary completed on the day of discharge," she said. "It's pretty straightforward. They are an essential part of communication during the transitional care period."
Kind noted that one in five Medicare patients is rehospitalized within 30 days of discharge. Reports also indicate 2 million nursing home patients require rehospitalization annually at a cost of $17 billion to the Medicare system.
"Our study did not specifically look at the impact of discharge summary quality on patient rehospitalization, but our future work will," she said.
According to Kind, the Rehospitalization Reduction Act, part of the healthcare reform legislation approved by Congress in 2010, may be a positive step in getting hospitals to provide patient healthcare information to nursing homes more quickly and reliably.
The act would penalize hospitals if their rehospitalization rates for patients with heart failure, myocardial infarction and pneumonia are above a certain level, starting in 2013.
"The writers of the law said it is not acceptable for Medicare to pay for rehospitalization for one out of five patients," Kind said. "If we can provide better care, hopefully, we can make the patients happier and save money for the system."
To read the study, which was funded by the UW Health Innovation Program and the National Institutes of Health, visit http://bit.ly/sLV5VP.
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