Study Reveals Hospital Discharge Summaries Often Delayed and Incomplete

Out of 46 hospitals reviewed in a nationwide study, none consistently produced discharge summaries that were timely, transmitted to an appropriate follow-up care provider, and included key content.

A study published in January, called Hospital Variation in Quality of Discharge Summaries for Patients Hospitalized With Heart Failure Exacerbation, studied discharge summaries from hospitals to analyze whether they met three criteria. Those criteria included timeliness, transmission to follow-up care provider and inclusion of standard data points. The results showed problems in all three of these areas.

Summaries Not Always Completed in a Timely Manner

Time stamps on the discharge summaries revealed that 67.2 percent of summaries were prepared on the day of discharge, 11 percent were prepared within three days, and 7.3 were prepared more than 30 days after the patient was discharged. Timeliness also corresponded to accuracy, as the study also showed that when summaries were completed on the day of discharge, important information was less likely to be left off.

Transmission to Follow-Up Providers Lacking

The study reviewed whether summaries were sent to a specific follow-up care provider, such as a primary care physician or specialist. Two-thirds of the median hospitals studied failed to send the summary to a specific provider. This is particularly worrisome as the study was specific to heart failure patients who are very likely to require follow-up care, thus making adequate discharge summary information even more important.

Vital Information Missing

The third criteria studied – content – included seven data care elements as set by the Transitions of Care Consensus Conference (TOCCC) in addition to the standard elements required by The Joint Commission. These include diagnosis, problem and medication lists, transferring physician name and contact information, cognitive status of patient, and test results – both completed and pending. Of the discharge summaries studied, the average included 3.75 of the 7 TOCCC standard data elements. In addition, less than two percent of discharge summaries included information about pending laboratory tests, and less than one percent included an attending physician’s contact information.

Nationwide Problem Regardless of Hospital Size or Location

Inadequate discharge summaries are common all over the Unites States, according to the study. The study reviewed 1,501 discharge summaries from 46 hospitals in 21 states and the District of Columbia. Regardless of geographic location, hospital size or type of community, hospitals are struggling to get discharge summaries out in a timely manner and with enough information for a successful transition of care. Even the most high-performing hospitals in the study were not able to send adequate discharge information to a follow-up provider.

Making Discharge Summaries More Useful Requires Change

The value of a discharge summary often lies in its immediate usefulness during a transition of care. If the follow-up provider does not receive the summary until a month after discharge, or if it does not include vital information about the patient’s hospital stay, the summary may not be useful. The study shows that hospital discharge summary processes could be improved, including earlier completion and formalized templates or guidelines for discharge documentation. According to the authors: “Collectively, these results suggest a need for quality improvement interventions, which might include a formal training process for discharge summary creation, institutional policy changes, audit/feedback or revision of electronic summary formats.”